BIOLOGY 

LIBRARY 


A  TEXT-BOOK  OF 

MILITARY  HYGIENE 

AND 

SANITATION 


BY 

FRANK  R.  KEEPER,  A.M.,  M.  D. 
n 

LIEUTENANT-COLONEL,    MEDICAL    CORPS,     UNITED    STATES    ARMY  ;      PKOFKSSOR 
OF    MILITARY    HYGIENE,      UNITED    STATES     MILITARY     ACADEMY,     WEST    POINT 


ILLUSTRATED 


PHILADELPHIA  AND  LONDON 

W.    B.   SAUNDERS    COMPANY 

1914 


BIOLOGY 

UBRARy 


Copyright,  1914,  by  W.  B.  Saunders  Company 


PRINTED     IN     AMERICA 

PRESS    OF 

W.     B.    SAUNOERS    COMPANY 
PHILADELPHIA 


PREFACE 


THE  chapter  on  Physical  Training  has  been  written  for 
this  book  by  Captain  H.  J.  Koehler,  U.  S.  Army  (Director 
of  Physical  Training  at  the  United  States  Military  Acad- 
emy, West  Point,  and  an  expert  of  international  repute). 

The  majority  of  the  illustrations  not  otherwise  credited 
were  prepared  by  Mr.  Stockbridge,  of  the  Department  of 
Drawing,  U.  S.  M.  A.,  through  the  courtesy  of  the  head 
of  that  Department. 

In  the  discussion  of  "  Alcohol  and  other  Narcotics,"  the 
aim  has  been  to  enable  pupils  to  form  an  intelligent  opinion 
upon  the  whole  subject  and  especially  to  distinguish  between 
mere  assertion  and  scientific  evidence.  While  certain  of  the 
data  in  this  chapter  cannot  be  accepted  as  wholly  proved, 
they  yet  represent  the  views  of  the  ablest  investigators 
everywhere.  With  a  clear  comprehension  of  the  matter, 
each  one  may  then  determine  for  himself  what  his  personal 
relations  with  these  substances  shall  be. 

To  save  the  time  of  the  pupil  and  to  avoid  the  necessity 
for  a- dictionary,  a  glossary  of  technical  terms  used  herein 
is  appended. 

FRANK  R.  KEEPER. 

July,  1914. 

13 


CONTENTS 


CHAPTER  I 

PAGE 

THE  CARE  OF  TROOPS 17 


CHAPTER  II 
RECRUITS  AND  RECRUITING 

CHAPTER  III 
PERSONAL  HYGIENE 31 

CHAPTER  IV 
PHYSICAL  TRAINING 41 

CHAPTER  V 

PREVENTABLE  DISEASES 59 

CHAPTER  VI 
CLOTHING 90 

CHAPTER  VII 
EQUIPMENT 108 

CHAPTER   VIII 
WATER-SUPPLY 122 

CHAPTER  IX 

FOODS  AND  THEIR  PREPARATION 139 

15 


16  CONTENTS 

CHAPTER  X 

PAGE 

THE  SANITATION  OF  POSTS,  BARRACKS,  AND  TRANSPORTS 161 

CHAPTER  XI 
THE    HYGIENE    AND    SANITATION    OF    MARCHES,    CAMPS,    AND 

BATTLEFIELDS 181 

CHAPTER  XII 
THE  DISPOSAL  OF  WASTES 206 

CHAPTER  XIII 

TROPICAL  AND  ARCTIC  SERVICE 235 

CHAPTER  XIV 
VENEREAL  DISEASES 250 

CHAPTER  XV 

ALCOHOL  AND  OTHER  NARCOTICS.  .     .  258 


GLOSSARY .  283 


INDEX .289 


MILITARY  HYGIENE 


CHAPTER   I 
THE  CARE  OF  TROOPS 

Definitions. — Hygiene  is  a  science  whose  laws  have  to 
do  with  the  preservation  of  the  health.  Sanitation  is  an 
art  whereby  man  endeavors  to  carry  out  the  laws  of  hygiene. 
Health  is  a  normal  condition  of  body  and  mind.  Disease  is 
any  departure  from  a  state  of  health.  Military  hygiene — 
sometimes  referred  to  as  the  "care  of  troops" — embraces 
hygiene  and  sanitation  in  their  relations  to  an  army.  In 
modern  military  usage  the  adjective  sanitary  is  applied  not 
only  to  hygienic  procedure,  but  also  to  troops  and  organi- 
zations of  the  Medical  Department. 

Scope  of  Military  Hygiene. — The  practice  of  military 
hygiene  covers  all  points  which  relate  to  the  public  health  of 
a  civil  community — and  something  more.  Public  health 
concerns  itself  with  everything  which  may  unfavorably 
affect  the  physical  condition  of  individuals  in  such  a  com- 
munity; in  other  words,  it  has  to  do  with  man  and  his  environ- 
ment. This  involves  a  consideration  of  soil,  air,  water,  cli- 
mate, habitations,  ventilation,  heating,  care  of  the  person, 

food,  clothing,  exercise,  occupation,  habits,  parasites,  COm- 
IS  17 


HYGIENE 


municable  diseases,  disinfection,  disposal  of  refuse,  sanitary 
laws,  and  vital  statistics.  The  "something  more"  is  the  set 
of  conditions  incident  to  the  march,  the  camp,  and  battle, 
which  greatly  modify  the  circumstances  and  increase  the 
difficulties  met  in  the  application  of  sanitary  procedures. 
A  knowledge  of  public  health  thus  falls  far  short  of  the  re- 
quirements for  the  military  service,  and  physicians  called 
from  civil  life  in  time  of  war,  without  previous  military  train- 
ing, find  themselves  not  qualified  properly  to  safeguard  the 
health  of  the  troops  entrusted  to  their  care. 

Functions  of  Medical  Officers. — Misconceptions  as  to  the 
functions  of  the  Medical  Department  are  not  uncommon  even 
in  the  army.  Since,  in  time  of  peace,  the  medical  officer  is 
best  known  through  his  relation  to  the  sick,  his  more  import- 
ant duties  may  be  overlooked.  His  prime  function  is,  in 
peace  or  war,  not  the  cure,  but  the  prevention,  of  disease. 
In  war  time  the  evacuation  of  the  sick  and  wounded  to  the 
rear,  that  they  may  not  encumber  the  army,  is  next  in  im- 
portance. The  care  of  the  sick,  essential  though  it  is  from 
ethical  and  political  considerations,  thus  assumes  relative 
insignificance  from  the  military  standpoint. 

Military  Failure  Due  to  Preventable  Diseases. — In  all 
the  wars  of  history  (with  the  doubtful  exception  of  the  Russo- 
Japanese  conflict)  much  more  disability  and  many  more 
deaths  have  resulted  from  disease  than  from  wounds.  Cam- 
paigns which  should  have  succeeded  have  frequently  failed 
because  of  the  utter  breakdown  of  armies  from  preventable 
diseases,  such  as  cholera,  plague,  typhoid,  typhus,  small- 
pox, malaria,  dysentery,  and  yellow  fever.  The  invasion 


THE  CARE  OF  TROOPS  19 

of  Canada  by  Montgomery  and  Arnold  in  1775  was  unsuc- 
cessful because  of  the  enormous  percentage  of  losses  from 
small-pox  and  dysentery.  Napoleon's  plan  to  found  a  colo- 
nial empire  in  what  is  now  the  Southern  United  States  failed 
because  15,000  men  of  his  fine  army,  sent  out  for  that  purpose 
in  1802,  perished  in  Santo  Domingo  of  yellow  fever  and  other 
tropical  diseases.  The  British  in  the  Crimea  lost  twenty-five 
times  more  men  from  disease  than  from  wounds.  Brief  as 
was  the  war  with  Spain,  deaths  from  sickness  in  our  army 
were  over  seven  times  more  numerous  than  were  those  from 
injury.  Even  in  the  Balkan  War,  recently  terminated,  the 
Bulgarian  campaign  (carried  on  at  first  with  such  fiery  vigor 
and  astonishing  success)  broke  down  largely  because  of  epi- 
demic disease.  The  occurrence  in  one  day  of  about  30,000 
cases  of  a  choleraic  dysentery  was  a  more  vital  factor  than 
was  the  Turkish  resistance  in  the  check  of  the  Bulgarian 
Army  at  Chatalja  and  its  failure  to  capture  Constantinople. 
Results  of  Prophylaxis. — Up  to  recent  years  a  high  per- 
centage of  disease  and  death  during  war  time  has  been  ac- 
cepted as  unavoidable,  and  but  little  effort  made  to  prevent 
the  one  or  to  lessen  the  other,  but  the  great  increase  in 
knowledge  of  the  causes  of  disease  has  given  us  weapons  with 
which  to  fight  these,  and  the  application  of  sanitary  principles 
has  resulted  in  a  marked  diminution  in  many  affections  now 
shown  to  be  preventable.  The  annual  death-rate  for  that 
half  of  the  United  States  which  keeps  reliable  statistics  has 
decreased  nearly  20  per  cent,  in  the  last  generation.  The 
average  length  of  life  at  present  is  about  forty-five  years, 
and  it  is  estimated  that  methods  of  disease  prevention  (so- 


20  MILITARY  HYGIENE 

called  prophylaxis),  if  properly  applied,  can  add  fifteen  years 
to  this.  The  sanitarians  of  our  army  have  kept  pace  with 
advances  along  this  line  and,  since  the  Spanish  War  created 
opportunities  for  them,  have  been  pioneers  in  blazing  trails 
through  uncharted  wildernesses  of  disease.  The  conquest 
of  yellow  fever  in  Cuba,  of  hookworm  disease  in  Porto  Rico, 
of  pernicious  malaria  in  Panama,  of  beriberi  among  Philip- 
pine scouts,  of  typhoid  fever  in  the  army  itself,  are  but  a  few 
examples  of  the  marvelous  results  of  the  application,  to  great 
problems  met,  of  the  principles  of  disease  prevention.  More 
recently  it  has  been  shown  in  the  large  camps  along  the 
Mexican  border  that  troops  can  be  maintained  under  canvas 
in  one  place  for  prolonged  periods  without  an  increase  in 
sickness  beyond  the  rates  usual  in  garrisons.  As  a  matter 
of  fact,  in  time  of  peace  at  least,  sick  rates  from  preventable 
diseases  are  .now  much  less  in  military  than  in  civil  com- 
munities. 

The  Soldier  and  Disease  Prevention. — Soldiers  are  special- 
ists in  a  certain  branch  of  human  endeavor,  the  practice 
of  which  entails  additional  risks  and  creates  the  necessity 
for  care  in  avoidance  thereof.  The  risks  of  battle  cannot  be 
avoided,  but  those  of  the  march  and  the  camp  can,  as  will  be 
shown,  be  entirely  escaped  or  greatly  lessened  by  the  exer- 
cise of  reasonable  caution.  The  prevention  of  disease  is  of 
supreme  importance  to  officers  of  the  line  because  the  effi- 
ciency of  the  troops  they  command  is  dependent  upon  health. 
The  vital  military  factor  is  the  soldier  himself,  and  the  avoid- 
ance of  wastage  in  this  particular  needs  no  emphasis.  A 
trained  soldier  is  of  more  value  than  are  several  raw  recruits. 


THE  CARE  OF  TROOPS  21 

If  such  soldier  can  be  kept  in  the  ranks,  or  returned  thereto 
promptly  after  sickness  or  injury,  the  system  is  a  great  asset 
to  the  company  commander  and  to  the  army.  But  such  a 
system  can  be  instituted  and  maintained  only  by  full  and 
hearty  co-operation  between  line  and  sanitary  officers,  in 
association  with  a  high  state  of  discipline.  That  elusive 
something,  known  to  us  under  the  French  term  esprit,  is 
engendered  and  fostered  in  troops  chiefly  by  confidence  in 
their  officers,  and  one  of  the  best  ways  to  gain  that  confidence 
is  by  letting  the  men  see  and  feel  the  active  interest  taken  in 
their  welfare. 

Enforcement  of  Sanitary  Regulations. — When  sanitary  reg- 
ulations are  promulgated  for  the  guidance  of  enlisted  men, 
it  is  often  desirable  to  let  them  know  the  reasons  therefor. 
Most  of  our  men  are  intelligent,  thinking  individuals,  and  if 
their  reason  is  appealed  to,  compliance  is  apt  to  be  more  thor- 
ough than  when  a  mere  command  is  given,  without  explana- 
tion. On  the  other  hand,  the  issuance  of  an  order  by  no 
means  ensures  compliance.  Every  order  must  be  followed 
up,  to  see  that  it  is  carried  out  promptly  and  habitually. 
For  this  purpose  inspections  must  be  made  early  and  often. 
If  a  disposition  to  shirk  is  observed,  delinquents  must  be 
punished.  Unless  the  system  of  inspection  and  responsi- 
bility is  thorough  and  complete  and  duties  of  subordinates 
dovetail  or  overlap,  work  will  be  neglected,  because  certain 
things  are  nobody's  business.  A  medical  officer  is  on  the 
staff  of  his  commander  in  an  advisory  capacity.  This  rela- 
tion should  not  be  lost  sight  of.  Recommendations  of  sani- 
tary officers  should  be  heeded  and  enforced  by  commanders. 


22  MILITARY  HYGIENE 

That  one  who  promptly  and  firmly  supports  his  sanitary 
adviser  soon  finds  the  sanitation  of  his  camp  or  garrison 
maintained  at  a  high  standard  by  those  most  directly  re- 
sponsible, namely,  the  company  commanders. 

Improvidence  of  Soldiers. — Experience  teaches  us  that  we 
cannot  expect  the  enlisted  man  to  care  for  himself,  so  we 
must  be  "guide,  philosopher,  and  friend"  to  him.  A  Con- 
federate leader  (Wise)  has  well  said,  "To  appreciate  fully  the 
truth  that  'men  are  but  children  of  a  larger  growth,'  one  must 
have  commanded  soldiers.  Without  constant  guidance  and 
governance  and  punishment  they  become  careless  about 
clothes,  food,  ammunition,  cleanliness,  and  even  personal 
safety.  They  will  at  once  eat  or  throw  away  the  rations 
furnished  for  several  days,  never  considering  the  morrow. 
They  will  cast  aside  or  give  away  their  clothing  because  to- 
day is  warm,  never  calculating  that  the  next  day  they  may  be 
suffering  for  the  lack  of  it.  They  will  open  their  cartridge- 
boxes  and  dump  the  contents  on  the  roadside  to  lighten 
their  load,  although  a  few  hours  later  their  lives  may  depend 
upon  having  a  full  supply.  When  they  draw  their  pay,  their 
first  object  is  to  find  some  way  to  get  rid  of  it  as  quickly  as 
possible.  An  officer,  to  be  really  efficient,  must  add  to  the 
qualities  of  courage  and  firmness  those  of  nurse,  monitor, 
and  purveyor  for  grown-up  children,  in  whom  the  bumps 
of  improvidence  and  destructiveness  are  abnormally  de- 
veloped." 


CHAPTER   II 
RECRUITS  AND  RECRUITING 

Mistaken  Views  of  Public. — Not  every  man  is  suitable  for 
a  soldier.  The  public — including  many  members  of  the 
medical  profession  in  civil  life — has  the  idea  that  any  male 
over  seventeen  years  of  age  and  not  enfeebled  by  senility  or 
disease  may  be  enlisted  and  perform  efficient  service.  Nor 
is  every  able-bodied  man  suitable  for  military  purposes. 
He  may  be  undesirable  as  to  character,  mentality,  habits, 
education,  or  temperament.  Furthermore,  though  the  indi- 
vidual may  be  muscularly  strong,  he  may  possess  some 
physical  defect  which,  though  negligible  in  his  ordinary  voca- 
tion, is  almost  certain  to  develop  into  a  disqualifying  defect 
in  the  military,  service.  Thus,  when  we  read  the  boastful 
utterances  of  Jingo  orators  about  "a  nation  in  arms,"  "ten 
millions  of  men  will  rise  to  repel  the  invader,"  and  the  like, 
we  must  realize  that,  from  the  standpoint  of  physical  fitness 
alone,  the  vast  majority  of  these  millions  is  totally  ineligible. 
A  man  may  be  a  good  insurance  risk  and  yet  be  entirely  un- 
fitted for  a  soldier. 

Small  Percentage  Qualified. — In  time  of  peace  a  sufficient 
number  of  applicants  ordinarily  present  themselves,  so  that 
our  small  army  may  be  recruited  out  of  good  material.  The 
number  of  men  rejected  for  one  reason  or  another,  but  chiefly 
on  account  of  physical  deficiencies,  greatly  exceeds  those 

23 


24  MILITARY  HYGIENE 

accepted.  Only  1  in  3  or  4  is  taken  by  officers  on  recruiting 
duty  in  cities,  and  this  percentage  is  still  further  reduced  by 
a  rigid  medical  scrutiny  at  recruit  depots,  to  which  pro- 
visionally accepted  applicants  are  sent  prior  to  taking  the 
oath  of  enlistment. 

High  Motives,  Special  Abilities. — The  motive  actuating  an 
applicant  for  enlistment — such  as  a  spirit  of  adventure,  a 
desire  to  wear  the  uniform,  or  even  a  strong  sentiment  of 
patriotism — is  not  a  satisfactory  substitute  for  physical  fit- 
ness. While  it  is  true  that  some  weedy  individuals  may  de- 
velop to  an  adequate  degree,  or  may  even  exhibit  a  rare 
courage  or  marked  endurance  under  strain,  experience  shows 
overwhelmingly  that  such  is  the  exception  and  not  the  rule. 
Exceptional  recommendations  as  to  character,  ability,  or 
knowledge  of  useful  trades  should  be  allowed  to  influence  us 
only  where  such  relative  defects  as  slight  deficiencies  in 
height  or  weight  are  concerned.  And  it  is  important  to  bear 
in  mind  that  there  must  be  not  merely  the  absence  of  disease 
or  abnormality,  but  also  freedom  from  any  tendency  thereto. 

Lowered  Standards. — At  times  of  special  urgency  there  is 
apt  to  be  great  pressure  directed  to  the  lowering  of  the 
standards.  Militia  organizations  may  desire  to  be  trans- 
ferred to  the  volunteer  service  intact;  officers  of  newly  or- 
ganized regiments  are  anxious  to  fill  the  ranks;  or,  a  real 
emergency  exists.  Even  at  such  times,  unless  the  emergency 
be  acute,  the  pressure  should  be  resisted,  for  the  inferior 
material  is  unlikely  to  reach  the  firing-line.  The  defective 
men  break  down  at  the  first  strain  and,  never  having  rendered 
real  service  to  their  country,  are  promptest  to  demand  pen- 


•      RECRUITS  AND  RECRUITING  25 

sions.  Woodhull  quotes  Vegetius  (a  celebrated  Roman 
military  writer)  as  follows:  "An  army  raised  without  due 
regard  to  the  choice  of  recruits  was  never  yet  made  a  good 
army  by  any  length  of  service." 

Regulars,  Volunteers,  Militia,  Conscripts. — In  our  military 
system  recruits  may  be  considered  under  four  heads,  namely, 
Regulars,  Volunteers,  Militia,  and  Conscripts.  Recruits  for 
the  first  three  are  all  volunteers,  in  the  sense  that  they  apply 
for  enlistment  of  their  own  free  will.  Those  for  the  last  are 
compulsorily  chosen  in  the  absence  of  a  sufficient  number  of 
voluntary  applicants.  Regulars  are  carefully  selected  by 
trained  officers  of  the  line  and  medical  staff.  Volunteers 
are  picked  in  like  manner,  but,  owing  to  the  inexperience  of 
examiners  or  pressure  to  lower  the  standards  somewhat,  the 
material  is  not  always  equal  to  that  of  the  Regulars.  This  is 
shown  by  the  fact  that  in  the  Civil  and  Spanish  wars  deaths 
from  disease  and  discharges  for  disability  were  nearly  twice 
as  great  among  the  Volunteers.  In  the  widest  sense  the 
militia  is  the  whole  number  of  males  of  the  country  who  are 
competent  and  available  for  military  service.  Specifically, 
the  term  is  applied  to  the  organized  militia,  these  being  the 
men  who  form  the  military  organizations  in  the  service  of  the 
several  states.  As  these  organizations — now  known  as  the 
National  Guard — are  not  ordinarily  liable  for  hard  field 
service,  some  states  do  not  require  a  very  high  standard  of 
physical  fitness.  When,  therefore,  in  conformity  with  exist- 
ing law,  the  organized  militia  may  be  called  into  the  service 
of  the  United  States,  it  will  be  found  that  from  one-half  to 
two-thirds  of  certain  regiments  are  physically  ineligible.  It  is 


20  MILITARY  HYGIENE 

an  interesting  but  readily  understandable  fact  that,  whereas 
voluntary  applicants  for  enlistment  endeavor  to  conceal 
defects,  conscripts  try  to  escape  service  by  magnifying 
existing  defects  or  feigning  non-existent  ones.  In  the 
examination  of  conscripts,  therefore,  a  skeptical  attitude  of 
mind  should  be  maintained  toward  alleged  disabilities. 

System  of  Examination. — Up  to  1907  the  physical  examina- 
tions were  made  largely  by  civilian  physicians,  employed 
under  contract,  at  recruiting  stations  in  cities.  Under  this 
system  great  losses  of  men  occurred  as  a  result  of  disabilities 
discovered  after  the  recruit  had  been  sworn  in.  At  the  same 
time  the  government  spent  much  money  for  the  transporta- 
tion and  clothing  of  these  defectives,  while  company  com- 
manders became  dissatisfied  on  account  of  the  poor  quality 
of  the  material  sent  them.  As  a  result  of  these  undesirable 
features  a  system  has  been  developed  whereby  line  officers 
make  a  careful  preliminary  examination  at  their  recruiting 
stations,  and  forward  likely  candidates  to  depots.  At  the 
latter  points  army  medical  officers  examine  these  candidates, 
weed  out  the  defective  ones,  and  enlist  those  qualified.  The 
Surgeon  General  reports  that  "the  present  recruiting  system 
operates  in  a  highly  satisfactory  manner  and  furnishes  to  the 
army  recruits  of  far  better  quality  than  when  they  were 
examined  under  the  former  system." 

Principal  Defects. — The  physical  deficiencies  which  cause 
the  greatest  number  of  rejections  for  our  army  are :  venereal 
diseases,  heart  abnormalities,  defective  vision  or  hearing, 
foot  deformities,  and  poor  physique.  While  it  is  not  to  be 
expected  that  line  officers  on  recruiting  duty  shall  be  able  to 


RECRUITS  AND  RECRUITING  27 

detect  obscure  affections  of  the  internal  organs,  there  are 
many  grosser  defects  which  are  readily  apparent  to  them. 
Such  are:  deformities,  skin  eruptions,  pallor,  emaciation, 
inebriety,  venereal  disease,  defective  development  of  parts, 
lice,  dirty  person,  rupture,  piles,  stiff  joints,  varicose  veins, 
flat  feet,  indecent  tattooing,  etc.  Furthermore,  internal 
disease  may  be  suspected  from  shortness  of  breath,  a  thump- 
ing heart,  dimness  of  vision,  or  irregular  pulse  following 
moderate  exertion. 

Character. — The  character  of  the  applicant  should  be 
determined  as  accurately  as  possible.  He  may  satisfy  all  the 
physical  requirements,  but  when  the  recruiting  officer  asks 
himself  the  question,  "Would  I  be  willing  to  have  this  man 
in  my  company?"  there  is  often  a  decided  negative.  And  this 
test  is  a  useful  one  to  apply  with  respect  to  the  intelligence  of 
the  applicant,  his  knowledge  of  English,  and  his  general  ap- 
pearance. The  moral  qualifications  may  be  guessed  from 
his  features  and  gaze  (open,  frank  or  averted),  his  manner 
(direct  or  furtive  and  hang-dog),  his  person  and  clothing 
(clean  or  dirty).  He  may  present  the  well-known  appear- 
ance of  a  drunkard  or  a  tramp.  Drug  habits  may  be  indi- 
cated by  numerous  marks  of  the  hypodermic  needle  or  very 
dilated  or  contracted  pupils.  A  marked  disproportion  of 
features  or  limbs  may  be  indications  of  degeneracy,  or  his 
body  may  be  much  tattooed,  some  of  the  subjects  being  of  an 
obscene  or  otherwise  offensive  nature. 

Mental  and  Nervous  Condition. — The  mental  and  nervous 
condition  is  important.  Many  defectives — especially  among 
the  foreign  born — pass  the  initial  observation  and  some  even 


28  MILITARY  HYGIENE 

the  medical  examination,  for  no  class  of  cases  is  so  difficult 
to  determine  without  an  extended  observation.  Neverthe- 
less, a  nervous,  shifty,  or  excitable  manner;  wandering  atten- 
tion; defective  memory;  inability  to  give  prompt  or  direct 
replies  to  questions;  sudden,  jerky  movements,  will  fre- 
quently indicate  an  unstable  nervous  system  or  defective 
mentality. 

Age. — Youth  is  a  serious  physical  defect.  We  sometimes 
read  the  erroneous  statement  that  the  Civil  War  was  fought 
by  boys,  but  in  that  war,  as  in  all  those  of  history,  unde- 
veloped, immature  youths  succumbed  to  the  fatigues  and 
privations  of  campaign  in  vastly  greater  proportion  than 
grown  men.  Prior  to  the  age  of  twenty-one  the  bones  are 
not  fully  formed,  the  muscles  lack  endurance,  and  the  heart 
is  unduly  susceptible  to  overstrain.  On  the  other  hand, 
men  over  thirty,  unless  thay  have  led  an  active,  alert  life, 
are  apt  to  be  muscle-bound  and  mentally  slow.  The  limits 
of  age  for  our  service  are,  in  time  of  peace,  eighteen  to  thirty- 
five.  It  is,  therefore,  to  be  seen  that  minors  may  be  legally 
accepted  in  spite  of  the  knowledge  that  great  commanders 
have,  for  centuries  past,  protested  against  the  recruitment 
of  boys  for  their  armies.  From  a  physiologic  standpoint 
the  truly  desirable  minimum  is  twenty-two  years. 

Height,  Weight,  Chest. — In  the  absence  of  actual  disease 
conditions,  the  physical  attributes  which  chiefly  determine 
the  acceptance  or  rejection  of  an  applicant  for  enlistment  are 
the  height,  the  weight,  and  the  chest  measurements.  In 
normal  individuals  these  bear  a  fairly  definite  relation  to  each 
other,  which  relation  is  set  down  in  official  tables.  Men 


RECRUITS  AND  RECRUITING  29 

whose  chest  circumference,  at  rest,  is  below  32  inches,  should 
not  be  accepted,  for  such  a  chest  has  not  sufficient  air  ca- 
pacity. The  present  minimum  of  height  is  5  feet  4  inches. 
The  question  of  height  is  not  quite  so  important  now  as  in 
the  days  of  shock  action.  Other  things  being  relatively 
equal,  the  smaller  man  is  generally  quicker  in  his  movements 
and  has  more  endurance.  In  these  days  of  specialism  we 
might  well  accept  vigorous  men  who  are  a  little  shorter  than 
the  present  requirement  for  special  service,  thus  releasing 
others  of  standard  height  for  the  fighting  line.  With  respect 
to  weight,  men  of  the  "wiry"  type  may  be  accepted  when  they 
are  but  a  few  pounds  under  the  standard,  but  the  mistake 
must  not  be  made  of  confusing  these  with  cases  of  defective 
or  arrested  development.  In  these  latter,  deficiency  in 
weight,  pallor,  flabby  muscles,  a  flat  chest,  sloping  shoulders, 
and  generally  poor  physique  denote  a  feeble  constitution. 

Records. — It  is  essential,  for  the  protection  of  the  govern- 
ment, that  careful  records  be  made:  (a)  of  all  departures 
from  the  normal,  including  minor  ones  which  are  not  con- 
sidered disqualifying,  and  (6)  of  means  of  identification.  The 
first  is  needed  as  a  defense  against  unjust  claims  for  pension. 
The  second  leads  to  the  detection  of  criminals,  deserters, 
bounty  jumpers,  and  dishonorably  discharged  men  who  en- 
list fraudulently. 

Depots. — Owing  to  the  widespread  derivation  of  recruits, 
depots  for  their  collection  and  training  are  frequently  afflicted 
with  one  or  more  kinds  of  contagious  diseases,  brought  by 
some  who  have  contracted  them  elsewhere.  It  has  some- 
times happened  that  measles,  mumps,  or  other  communi- 


30  MILITARY  HYGIENE 

cable  disease  has  developed  in  parties  of  men  sent  from 
depots,  during  the  trip  or  shortly  after  arrival  at  their 
destination.  Army  posts  have  thus  been  frequently  infected, 
while  the  health  of  the  traveling  public  has  been  endangered. 
If,  therefore,  such  a  disease  exists  at  depots,  the  men  who 
have  been  exposed  to  contagion  should  be  isolated,  in  sepa- 
rate squads,  until  the  period  of  incubation  of  that  particular 
disease  is  past.  If  a  case  develops  in  any  one  squad,  none  but 
members  of  that  squad  have  been  exposed  to  it  and  the  others 
may  safely  be  forwarded.  A  similar  procedure  is  advisable 
in  camps. 

Vaccinations. — One  of  the  first  requirements  after  the 
enlistment  of  a  man  is  to  have  him  vaccinated  against 
small-pox  and  typhoid  fever.  This  is  a  very  important  pro- 
cedure, looking  to  his  future  health  and  that  of  the  army. 

General  Order  No.  66. — The  remarks  in  this  chapter  are 
intended  to  emphasize  the  importance  of  sound  recruits 
and  sound  methods  of  recruiting.  The  most  important  part 
of  the  whole  subject,  namely,  the  physical  examination  of  the 
recruit,  is  not  dealt  with  herein,  for  the  reason  that  War 
Department  General  Order  No.  66,  series  of  1910,  is  an 
excellent  presentation  thereof. 

If  in  Doubt,  Reject. — Recruiting  is  a  highly  important 
duty,  for  upon  those  to  whom  it  is  entrusted  rests  the  re- 
sponsibility for  the  physical,  mental,  and  moral  standard 
of  the  whole  army.  Officers  assigned  to  this  duty  should 
keep  in  mind  constantly  the  maxim,  //  in  doubt,  reject. 


CHAPTER  III 
PERSONAL  HYGIENE 

Nature  and  Importance. — Personal  hygiene  means  pres- 
ervation of  health  by  attention  to  the  care  of  the  body.  It ' 
is  obvious  that  such  care  is  essential  to  keep  the  physical 
character  of  the  soldier  up  to  the  proper  standard.  Napoleon 
is  reported  to  have  said,  "The  most  important  quality  of 
the  soldier  is  his  ability  to  support  fatigue  and  privation; 
physical  courage  is  only  second."  Whether  or  not  this  be 
true,  it  must  be  apparent  to  any  thinking  individual  that 
personal  merits,  including  courage,  are  of  little  avail  to  the 
military  man  if  he  has  not  bodily  vigor. 

Formation  of  Correct  Habits. — Military  efficiency  in  an 
individual,  then,  rests  upon  certain  considerations,  chief 
among  which  are  health,  strength,  and  activity.  To  secure 
and  keep  these  qualities  it  is  essential  for  every  man  to  form 
such  habits  as  experience  has  shown  to  be  necessary.  These 
habits  are:  personal  cleanliness;  regulation  of  diet;  avoidance 
of  excesses  (particularly  in  eating,  drinking,  and  sexual 
matters);  wearing  suitable  clothing;  keeping  the  bodily 
processes  at  work  (kidneys,  bowels,  skin);  taking  sufficient 
exercise,  preferably  in  the  open  air;  devoting  a  proper  part  of 
each  day  to  rest  of  body  and  mind,  with  recreation  for  the" 
latter;  maintaining  the  surroundings  in  which  one  lives,  in  a 
cleanly  state. 

31 


32  MILITARY  HYGIENE 

Anatomy  and  Physiology. — In  the  discussion  of  this  branch 
of  our  subject,  an  elementary  knowledge  of  anatomy  and 
physiology  must  be  assumed,  as  the  scope  of  this  work  does 
not  permit  of  instruction  in  these  topics. 

Personal  Cleanliness. — The  maintenance  of  personal  clean- 
liness is  even  more  necessary  in  the  military  service  than  in 
civil  life.  This  is  due  in  part  to  the  violent  exercises  re- 
quired of  the  soldier,  with  the  resultant  dirt  and  sweat, 
but  especially  because  so  many  live  together  within  a  small 
space. 

Baths  and  Bathing. — The  most  important  requirement  to 
insure  cleanliness  is  bathing.  Baths  are  necessary  partly  to 
rid  the  skin  of  external  impurities,  but  chiefly  to  keep  open 
the  "pores,"  which  are  the  mouths  of  the*  sweat-glands,  whose 
product  carries  away  large  amounts  of  waste  and  poisonous 
matters  from  the  blood.  Each  man  has  a  preference  for  a 
certain  temperature  of  the  water  in  which  he  takes  his  bath; 
this  varies  from  freezing  to  hot.  A  cold  bath  is  stimulating 
and  is  to  be  preferred  for  a  vigorous  man,  provided  he 
"reacts"  well  and  feels  a  glow  on  emerging  from  the  bath  and 
rubbing  down.  The  cold  bath  is  not  suited  to  elderly  men 
nor  to  those  whose  circulation  is  poor.  The  proper  time 
for  cold  bathing  is  on  arising  in  the  morning,  not  at  bedtime, 
as  sometimes  indulged  in. 

It  is  worthy  of  mention  that  the  practice  of  cold  bathing 
often  breaks  up  the  habit  of  "taking  cold,"  to  which  certain 
people  are  liable. 

Hot  and  warm  baths  are  soothing  and  best  remove  surface 
dirt;  they  are  grateful  means  of  reducing  muscular  soreness 


PERSONAL  HYGIENE  33 

after  exertion,  and  will  often  induce  sleep  in  a  restless,  wake- 
ful person. 

The  most  desirable  means  of  bathing  is  perhaps  in  a  tub 
in  which  the  whole  body  may  be  immersed ;  in  default  of  this 
and  particularly  in  barracks,  the  shower-bath  is  very  satis- 
factory. If  means  for  complete  bathing  are  not  available, 
careful  attention  should,  in  any  event,  be  given  to  the  daily, 
cleansing  of  the  armpits,  crotch  and  feet,  as  well  as  the  hands 
and  face.  The  hands  should  be  washed  after  defecation 
and  urination,  lest  they  convey  disease  germs.  The  nails 
must  be  well  kept  and  clean.  On  the  march,  if  no  water  is 
available,  a  vigorous  "dry  rub"  with  a  coarse  towel  will  be 
found  refreshing  as  well  as  cleansing.  The  scalp  should  be 
washed  at  least  once  or  twice  a  month  and  should  be  stimu- 
lated daily  by  brisk  rubbing  with  a  brush  or  the  fingers. 

Care  of  the  Teeth. — Every  man  should  own  a  good  tooth 
brush  and  use  it  with  a  tooth  powder  or  mild  antiseptic 
(listerine  for  instance)  at  least  twice  a  day.  If  no  tooth 
powder  is  available,  wood  ashes  or  wood  charcoal  make 
efficient  substitutes. 

Clothing. — Since  clothing  (especially  the  underwear) 
when  soiled  with  sweat  and  dust  is  irritating  to  the  skin  and 
gives  off  disagreeable  odors,  it  is  necessary  to  keep  this  -as 
clean  as  the  body.  The  soldier  cannot  keep  his  person  clean 
if  his  garments  are  filthy.  Therefore,  whenever  possible,  the 
soiled  clothing  should  be  washed  (and  with  soap  if  it  can  be 
had).  If  the  articles  are  of  wool,  they  should  be  washed  in 
cold  water  and  dried  without  wringing.  On  the  march  a 

man  should  have  two  suits  of  underclothes  to  wear  on  alter- 

3  * 


34  MILITARY  HYGIENE 

nate  days,  thus  ensuring  cleanliness  if  the  garments  are  regu- 
larly washed.  If,  at  the  end  of  the  day's  march,  water  is  not 
available  for  this  purpose,  the  garments  should  be  dried,  then 
beaten  or  well  rubbed,  and  hung  up  in  the  air. 

Skin  Diseases. — In  campaign,  skin  diseases  due  to  ani- 
mal parasites — especially  lice  and  the  itch  mite — usually 
make  their  appearance  and  cause  much  disgust  and  discom- 
fort. They  must  be  watched  for  and  report  of  their  presence 
promptly  made  to  the  medical  officer. 

Diet. — In  the  soldier's  life  the  diet  is,  of  course,  regulated 
as  far  as  possible  by  the  authorities,  who  design  and  issue  the 
ration  and  train  the  cooks  by  whom  the  articles  composing 
it  are  prepared.  In  campaign,  military  considerations  may 
necessitate  cutting  away  from  the  base  of  supply,  so  that 
soldiers  are  obliged  to  live  on  the  resources  of  the  country 
in  which  they  are  operating  or  even  to  subsist  for  a  few  days 
upon  the  emergency  ration.  Every  soldier  should  be  required 
to  learn  how  to  prepare  his  individual  field  ration,  since  the 
necessity  for  this  frequently  occurs  in  field  service. 

The  character  of  the  food  taken  should  vary  in  accord- 
ance with  the  conditions  of  bodily  vigor,  occupation,  climate, 
and  food  values.  A  vigorous  man,  doing  heavy  work,  re- 
quires more  nourishment  than  one  of  delicate  physique 
following  a  sedentary  pursuit.  Climate  is  an  important 
factor.  Men  serving  in  Alaska  need  a  large  amount  of 
fats  to  serve  as  fuel  in  maintenance  of  the  temperature 
balance.  Those  on  o!uty  in  the  Philippines  require  a  large 
proportion  of  sugars  and  starches. 

"Fletcherizing,"  that  is,  the  chewing  of  food  until  it  is 


PERSONAL  HYGIENE  35 

completely  disintegrated,  makes  eating  a  bore.  Other 
food  fads,  such  as  strict  vegetarianism  or  eating  only  when 
the  sensation  of.  hunger  is  felt,  usually  result  in  digestive 
disorders  or  loss  of  strength. 

Dietary  Dont's.— A  few  general  dietary  principles  follow, 
which  may  perhaps  best  be  expressed  in  the  form  of  prohibi- 
tions : 

Don't  eat  hurriedly. 

Don't  swallow  a  morsel  till  it  is  thoroughly  broken  up  and 
mixed  with  the  saliva  by  chewing. 

Don't  overload  your  stomach,  but  get  up  from  the  table 
feeling  that  you  could  eat  a  little  more  with  relish. 

Don't  eat  unripe  or  overripe  fruit. 

'Don't  eat  anything,  while  away  from  camp  or  barracks, 
whose  materials  or  mode  of  preparation  may  seem  ques- 
tionable. 

Don't  bring  worry  or  a  "grouch"  to  table  with  you. 

Excess  in  Eating. — Overeating  gives  rise  to  biliousness  and 
other  forms  of  dyspepsia  and  overloads  the  body  tissues  with 
waste  matters.  These  wastes  are  irritant  substances  and 
are  just  as  likely  as  alcohol  to  cause  kidney  disease,  gout, 
obesity,  and  hardening  of  the  arteries.  Beefy,  overfed  men 
are  especially  liable  to  apoplexy. 

Excess  in  drinking  means,  to  us  all,  overuse  of  drinks  con- 
taining alcohol  in  some  form.  You  will  learn  that  the  great 
majority  of  violations  of  discipline,  trials  by  court-martial, 
and  subsequent  punishment  in  our  army  result  from  this 
particular  excess.  Habitual  indulgence  in  alcohol  brings, 
as  certain  rewards,  a  host  of  physical  and  mental  ailments. 


36  MILITARY  HYGIENE 

Besides  weakening  men  physically,  alcohol  tampers  with  their 
will  power,  disturbs  their  temper,  and  makes  them  less  trust- 
worthy even  when  sober. 

Sexual  Indulgence. — It  is  the  popular  idea  that  a  young 
man  must  exercise  the  sexual  function  to  some  extent  in  order 
that  he  may  retain  his  vigor.  This  belief  is  not  founded  on 
fact,  for  the  sexual  act  is  not  necessary  to  preserve  the  health 
or  powers  of  a  man.  Not  only  is  this  true,  but  it  is  equally 
true  that  sexual  indulgence  by  young  unmarried  men  is 
responsible  for  an  immense  amount  of  disease  and  suffering. 
This  disease  and  suffering  is  borne  not  only  by  the  men  them- 
selves, but,  in  a  large  proportion  of  cases,  by  the  innocent 
women  whom  they  afterward  marry  and  by  their  children. 
The  wives  may  be,  and  often  are,  infected  years  after  an  ap- 
parent cure  has  resulted,  and  the  children  are  born  diseased. 

Masturbation. — The  habit  of  masturbation  is  degrading 
and  is  likely  to  interfere  with  the  normal  development  of 
the  sexual  organs.  It  may  also  be  responsible  for  early  loss 
of  sexual  power  (impotence). 

Clothing. — The  prime  purpose  for  which  clothing  is  worn 
(other  than  that  of  decency)  is  to  afford  protection  to  the 
body  against  extremes  of  cold  and  heat.  The  materials  used 
should,  therefore,  be  such  as  to  conserve  the  natural  warmth 
of  the  body  or  to  allow  it  to  escape  freely,  in  accordance  with 
weather  conditions.  Clothing  should  not  be  permitted  to 
interfere  with  the  circulation  of  the  blood,  nor  with  the  nor- 
mal movements  of  the  body. 

Excretory  Functions. — Our  bodies,  in  the  work  their  va- 
rious parts  must  perform,  manufacture  certain  waste  prod- 


PERSONAL  HYGIENE  37 

ucts  which  we  call  excretions.  Now  it  is  evident  that  if  we 
do  not  get  rid  of  these  substances,  they  will  clog  up  the  body 
or  even  act  as  poisons.  Nature  has,  therefore,  designed  cer- 
tain avenues  of  escape  for  these  excretions,  and  the  chief  of 
these  are  the  skin,  the  kidneys,  the  bowels,  and  the  lungs. 
The  importance  of  the  skin  has  already  been  dwelt  upon. 
The  kidneys  can  best  be  kept  in  good  condition  by  drinking 
plenty  of  water  (at  least  6  or  8  glasses  a  day),  which  flushes 
these  organs  and  dilutes  the  solid  impurities  of  the  urine. 
Constipation  induces  a  variety  of  uncomfortable  conditions, 
among  which  piles,  headache,  the  state  often  called  "bilious- 
ness," and  mental  depression  are  frequent;  moreover,  certain 
acute  diseases  seem  more  readily  to  attack  a  constipated 
person.  Therefore,  remember  to  keep  your  bowels  open. 

Lungs.— The  lungs  are  an  important  avenue  of  escape  for 
certain  waste  products,  chief  of  which  is  carbon  dioxid.  The 
ventilation  of  living  rooms  thus  becomes  desirable  to  dilute 
or  carry  off  these  wastes,  to  renew  that  most  vital  element, 
oxygen,  and  to  prevent  overheating  and  undue  moisture  of 
the  atmosphere,  which  latter  are  important  factors  tending 
to  the  diminution  of  vitality.  The  germs  of  diseases  which 
affect  the  respiratory  tract  are  thrown  off  into  the  air  and 
are  likely  to  be  breathed  by  healthy  individuals,  who  are 
thus  in  turn  infected.  "Colds"  result  more  often  from 
overheated,  poorly  ventilated  rooms  than  as  the  result  of 
drafts  and  chilling.  Such  colds  are  often  contagious.  The 
transmission  of  tuberculosis  and  such  acute  infectious  dis- 
eases as  measles,  scarlet  fever,  influenza,  and  whooping- 
cough  is  favored  by  poor  ventilation. 


38  MILITARY  HYGIENE 

Exercise. — A  sufficient  amount  of  exercise  to  maintain 
health  is  ordinarily  provided  by  military  drills  and  other 
duties  requiring  active  movement.  Nevertheless,  the  phys- 
ical condition  is  further  improved,  muscular  size  and  strength 
greatly  increased,  and  the  mental  outlook  rendered  more 
cheerful  by  athletic  exercises,  whether  in  the  open  air  or  the 
gymnasium.  A  proper  appreciation  of  the  benefits  of  phys- 
ical exercise  may  be  gained  by  a  mental  comparison  between 
the  rugged  condition  of  a  man  who  exercises  regularly,  and 
the  poorly  developed  muscles  and  sallow  skin  of  another 
who  has  some  occupation  which  keeps  him  indoors  at  work 
of  a  light  sort.  The  improvement  is  brought  about  by  the 
increased  activity  not  merely  of  the  muscles,  but  of  every  part 
of  the  body,  including  the  heart,  lungs,  skin,  digestive  appa- 
ratus, etc.  Like  all  good  things,  however,  exercise  may  be 
overdone;  excessive  rapidity  or  irregularity  of  the  heart's 
action  and  labored  breathing  are  warnings  to  stop  and  rest. 
Soldiers  in  campaign — especially  immature  boys  who  are 
sometimes  enlisted — are  very  liable  to  heart  strain  and  an 
"irritable"  condition  of  that  organ. 

Arteries. — "A  man  is  as  old  as  his  arteries,"  and  some  men 
grow  old  in  this  respect  much  sooner  than  the  average,  so 
care  must  be  taken  to  suit  the  exercise  to  their  condition. 

The  amount  and  kind  of  exercise  best  suited  to  each  must 
be  determined,  as  these  vary  widely  in  different  individuals. 
There  are  men  who  require  the  equivalent  of  a  brisk  15-mile 
daily  walk  to  keep  in  a  satisfactory  physical  state,  while  the 
ordinary  occupation  of  others  suffices  to  maintain  them  in 
excellent  health. 


PERSONAL  HYGIENE  39 

Rest. — For  the  repair  of  damaged  tissues  and  the  relief  of 
fatigue,  a  certain  amount  of  rest  for  both  mind  and  body  is 
necessary.  Different  people  vary  considerably  in  their  re- 
quirements, but  it  may  be  set  down  as  a  fair  average  that 
eight  hours  of  sleep  in  each  twenty-four  hours  are  needed  to 
keep  the  faculties  at  their  best.  In  addition,  work  of  any 
sort,  physical  or  mental,  must  be  intermitted  by  brief  periods 
of  relaxation.  Mental  overwork  is  very  common  in  these 
days  of  complex  civilization,  and  exhaustion  of  the  nervous 
system  (neurasthenia)  takes  a  long  time  for  its  recovery. 

Recreation. — The  risk  of  overtaxing  the  mind  is  greatly 
lessened  by  measures  of  recreation,  which  may  take  any 
proper  form  most  agreeable  to  the  individual.  The  cultiva- 
tion of  a  fad  is  of  especial  value.  The  habit  of  worry,  of 
"crossing  bridges  before  one  comes  to  them,"  must  be  avoided. 
Fits  of  "the  blues,"  if  yielded  to,  tend  to  increase  in  number 
and  length  and  finally  to  unfit  one  for  work.  In  garrison,  on 
transports,  and  particularly  in  winter  camps  during  war  time, 
we  must  make  provision  for  measures  of  recreation.  These 
are  essential  to  promote  cheerfulness  and  contentment,  to 
prevent  ennui,  and  to  lessen  the  tendency  to  abuse  of  alcohol 
and  tobacco,  gambling,  and  perversion  of  the  generative 
function.  Entertainments  of  all  sorts,  but  more  particularly 
those  participated  in  by  the  men  themselves,  competitions 
and  contests,  reading  rooms,  and  opportunities  for  following 
and  learning  mechanical  trades  must  be  provided. 

Cleanliness  of  Surroundings. — It  is  not  sufficient  merely 
to  keep  our  bodies  in  a  state  of  cleanliness  by  the  measures 
previously  outlined.  We  must  also  keep  our  surroundings 


40  MILITARY  HYGIENE 

—the  house  and  grounds  in  which  we  live — well  "policed," 
as  the  expression  goes  in  our  military  service.  It  is  self- 
evident  that  where  people  live — especially  where  many  people 
are  congregated  in  a  small  space — there  much  dirt  will  collect. 
This  refers  not  so  much  to  earthy  particles  as  to  the  so-called 
organic  materials  which  are  derived  from  animal  and  vege- 
table sources.  Under  this  head  fall  the  body  discharges, 
refuse  from  the  kitchen,  spit,  decaying  flowers  and  weeds, 
cigar  stubs,  floor  and  stable  sweepings,  and  the  like.  These 
must  be  received  in  vessels  specially  kept  for  them  and 
frequently  removed,  or  they  give  off  foul  odors,  pollute  the 
ground,  attract  hosts  of  flies,  and  act  as  breeding-places  for 
the  germs  of  disease. 


CHAPTER  IV 
PHYSICAL  TRAINING 

Necessity  for  Bodily  Activity. — Every  human  being  is 
born  with  a  natural  craving  for  bodily  activity,  and  it  is 
largely  upon  the  employment  of  this  inherent  instinct  that  the 
perpetuation  and  the  survival  of  our  species  depends.  Since 
the  growth  and  development  of  the  entire  human  organism 
in  all  its  complexity  is  determined  by  the  manner  in  which 
this  craving  is  satisfied,  it  is  necessary,  under  the  present 
conditions  of  life,  that  it  should  conform  to  some  well-defined, 
well-regulated  methods,  rationally  applied,  in  order  that  the 
evolution  of  the  ovum  of  origin  from  which  the  individual 
is  derived,  and  which  predetermines  and  defines  his  capa- 
bilities in  all  directions,  may  be  restricted  only  by  its  limita- 
tions. 

Physical  Education  More  Vital  than  Mental. — From  the 
beginning  of  civilization  every  state  has  been  more  or  less 
seriously  concerned  with  the  development  of  the  mental  and 
moral  possibilities  of  this  germ-plasm,  but,  if  we  except  the 
Greeks,  whose  theory  of  education  and  its  results  have  not 
been  equalled  to  the  present  time,  none  has  as  yet  made  any 
official  effort  to  place  the  advancement  of  the  physical  possi- 
bilities upon  the  same  high  plane  as  the  intellectual.  For 
centuries  the  mind  has  been  developed  without  regard  to  the 
body  and  ofttimes  at  the  expense  of  the  latter.  Even  today, 

41 


42  MILITARY  HYGIENE 

in  the  light  of  all  the  progress  that  has  been  achieved,  it 
would  require  more  temerity  than  most  educators  possess  to 
advance  the  perfectly  sound  doctrine,  that  because  of  its 
priority  in  the  order  of  development  of  the  human  species, 
and  by  reason  of  the  fact  that  it  is  the  physical  that  deter- 
mines the  destiny  of  the  intellectual,  precedence  should  be 
given  the  former  over  the  latter  in  any  system  of  education 
founded  upon  a  rational  physiologic  basis. 

Dangers  of  Present  Environment. — From  a  physical  point 
of  view,  at  least,  all  culture  of  civilization  is  unnatural,  since 
it  removes  man  farther  and  farther  from  the  environment 
of  his  origin,  and  deprives  him,  in  a  greater  or  less  degree,  of 
the  opportunity  to  use  many  of  his  faculties  in  the  manner 
in  which  nature  decreed  they  should  be  used.  The  primitive 
and  simple  methods  of  life  that  made  for  physical  and  moral 
hardihood  have  become  obliterated,  and  in  their  stead  we  are 
living  in  an  environment  of  artificiality.  On  the  one  hand 
we  have  a  multitude  of  conveniences,  luxuries,  and  affluence. 
On  the  other  there  are  overcrowded  communities  with  all 
their  attendant  evils,  deprivations,  and  restrictions.  These 
latter  social  conditions  impose  upon  a  very  large  portion  of 
the  inhabitants  of  all  great  centers  with  respect  to  labor,  hab- 
itation, nourishment,  morality,  and  general  physical  welfare, 
injurious  circumstances  which,  if  not  constantly  and  persist- 
ently restricted,  must,  in  the  natural  order  of  things,  lead  to 
the  serious  incapacity  of  any  race. 

Hygienic  Education. — It  was  only  when  unmistakable 
symptoms  of  the  existence  of  such  conditions  began  to  mani- 
fest themselves  in  our  own  country  that  there  was  a  general 


PHYSICAL  TRAINING  43 

awakening  to  the  urgency  of  the  application  of  some  efficient 
remedy  to  counteract  them.  But  little  attention  had  up  to 
this  time  been  paid  to  the  enforcement  of  the  principles  of 
hygiene,  personal  and  general,  and  as  this  was  the  remedy 
that  must  be  depended  upon  to  ameliorate  this  condition, 
every  effort  was  made  to  bring  the  laws  of  clean  and  whole- 
some living  within  the  understanding  of  all.  The  study 
of  hygiene  was  introduced  into  the  curriculum  of  even  ele- 
mentary schools;  laws  governing  sanitation,  habitation,  food, 
etc.,  were  enacted,  and  other  steps  were  taken  to  impress  the 
importance  of  these  rules  upon  the  public  in  general:  as  a 
result  the  average  person  today  appreciates  their  necessity. 
Importance  to  the  State. — This  remedy's  chiefest  adjunct, 
one  that  has  been  almost  universally  adopted,  consists  of 
various  methods  of  physical  training,  comprising  gymnastics, 
athletics,  games,  and  sundry  pastimes  and  accomplishments 
in  which  bodily  effort  dominates.  While  an  immense  amount 
of  good  has  already  been  accomplished  by  the  now  rather 
general  indulgence  in  the  various  forms  of  physical  activity 
on  the  part  of  our  people,  and  while  the  value  of  this  indul- 
gence and  its  importance  is  constantly  finding  more  recogni- 
tion, the  full  measure  of  the  advantages  they  offer  will  never 
accrue  to  our  citizens  until  physical  training  is  made  a 
compulsory  part  of  the  curriculum  of  all  our  schools  and  insti- 
tutions of  learning,  and  is  treated  with  precisely  the  same 
dignity  with  which  the  intellectual  requirements  are  treated. 
For  it  is  only  when  it  is  recognized  that  "  'Tis  not  a  soul,  'tis 
not  a  body  we  are  training,  but  a  man,  and  we  must  not 
divide  him,"  that  we  shall  be  doing  our  full  duty  to  our  fel- 


44  MILITARY  HYGIENE 

lows  and  to  our  country,  which  at  present,  on  account  of 
physical  inefficiency,  is  forced  to  depend  upon  less  than  50 
per  cent,  of  the  male  population  between  the  ages  of  eighteen 
and  forty-five,  to  bear  arms  in  her  defence. 

Object  of  Training. — A  rational  course  of  physical  training 
must  have  for  its  primary  object  the  development  of  the  human 
organism  in  its  entirety  by  the  employment  of  means  that 
will  give  to  each  separate  part  of  that  organism,  that  which 
will  aid  in  its  development  and  assist  it  in  the  discharge  of  its 
peculiar  functions,  with  the  facility  that  nature  intended, 
thereby  establishing  a  corelation  between  these  various  organs 
that  will  produce  the  harmonious  organic  balance  which  is 
termed  perfect  health.  In  order  to  insure  the  maintenance 
of  this  balance,  training  must  further  endeavor  to  develop 
the  recuperative  and  resistive  powers  of  all  the  organs  to 
such  an  extent  that  each  has  an  excess  amount  of  vigor  at  its 
disposal,  against  which  it  may  draw  in  its  own  favor  or  in 
favor  of  the  others  when  the  exigency  therefor  presents  itself. 

Interrelation  Between  Intellectual  and  Physical  Func- 
tions.— While  the  efficiency  of  other  human  qualifications  is 
determined  by  physical  fitness,  the  degree  of  the  latter  is  often 
determined  by  the  use  that  is  made  of  the  former.  In  other 
words,  the  amount  and  nature  of  the  training,  over  and  above 
that  which  is  indulged  in  for  the  purpose  of  keeping  the  body 
in  a  healthful  condition,  is  determined  by  the  physical  ob- 
stacles that  the  individual  must  surmount  in  order  that  he 
may  exercise  his  intellectual  faculties  to  the  best  advantage. 
A  perfect  relation  between  the  two  is  possible  only  when  the 
physical  is  prepared  to  back  the  intellectual  with  the  necessary 


PHYSICAL  TRAINING  45 

stamina.  It  is  because  of  this  fact  that  a  great  difference 
must  exist  between  the  training  that  prepares  men  for  the 
ordinary  pursuits  of  life  and  that  which  fits  them  for  the 
military  profession.  With  the  former,  it  is  a  question  of  the 
individual  and  his  personal  needs,  with  only  an  indirect  and 
indefinite  bearing  upon  the  welfare  of  the  state.  With  the 
latter,  it  is  a  question  of  the  individual  only  so  far  as  his  rela- 
tion to  the  requirements  of  the  service  is  concerned,  while  it 
has  a  direct  and  definite  bearing  upon  the  welfare  of  the  state. 
The  one  is  an  independent,  the  other  an  interdependent,  unit. 

Physical  Training  for  Military  Purposes. — Training  men 
physically  for  offensive  and  defensive  purposes  dates  back  to 
prehistoric  times,  and  from  that  period  to  the  present  it 
alone  has  remained  a  constant  and  unvarying  quantity  in  the 
preparation  of  men  for  military  purposes.  Then,  as  now, 
physical  aptitude  was  the  rock  upon  which  every  military 
establishment  was  founded,  for  experience  has  proved  con- 
clusively that  upon  it,  more  than  upon  all  the  other  compo- 
nents of  military  education  combined,  success  depends. 
The  physical  superiority  of  the  Greeks,  the  unequaled  hardi- 
hood of  the  Spartans,  and  the  wonderful  achievements  of  the 
Romans  are  all  directly  traceable  to  the  effects  of  this  training 
in  ancient  times,  while  in  recent  times  the  remarkable  mobil- 
ity of  the  Germans  in  1870  and  of  the  Japanese  in  1904  can 
be  attributed  to  no  other  reason  than  that  of  superior  physical 
condition  and  training. 

Modern  Tendency. — The  notable  progress  made  in  the 
art  of  war,  which  has  not  hesitated  to  seek  the  co-operation 
of  all  the  sciences  in  its  development,  is  constantly  demanding 


46  MILITARY  HYGIENE 

a  higher  degree  of  intelligence  on  the  part  of  its  various  indi- 
vidual units,  with  the  result  that  there  is  a  tendency,  par- 
ticularly in  our  service,  to  undervalue  the  importance  of  first 
principles  in  a  direct  ratio  to  the  importance  that  is  attached 
to  the  mentality.  This  tendency,  if  continued,  is  liable  to 
lead  to  the  impairment  of  our  army's  effectiveness  by  pro- 
ducing a  condition  wherein  "the  will  is  strong,  but  the  flesh 
weak." 

Requirements  for  the  Military  Service. — From  a  military 
point  of  view,  the  individual  is  considered  only  with  reference 
to  the  service,  whose  requirements  determine  the  nature  and 
extent  of  his  personal  training,  i.  e.,  there  are  certain  fixed 
standards  that  he  must  measure  up  to  before  he  is  considered 
a  dependable  effective.  Since  these  requirements,  as  has 
been  stated  before,  are  far  in  excess  of  those  demanded  of 
men  in  the  ordinary  walks  of  life,  with  respect  to  degree, 
variety,  and  severity,  it  is  not  sufficient  for  a  soldier  to  be 
healthy  and  organically  sound;  his  profession  demands  more 
of  him.  He  must  possess  more  than  the  average  amount  of 
muscular  strength,  endurance,  and  organic  vigor;  he  must  be 
inured  to  the  ill  effects  of  exposure  by  having  the  powers  of 
resistance,  inherent  in  every  individual,  fully  developed, 
so  that  he  may  be  prepared  to  exchange  the  comparative 
comforts  of  garrison  life  for  the  hardships  of  field  service  at 
any  time  without  diminishing  his  effectiveness.  He  must 
be  trained  to  husband  and  use  his  physical  faculties  to  the 
best  advantage,  and  be  taught  to  become  skilful  in  every- 
thing pertaining  to  his  profession,  thus  instilling  him  with 
confidence,  self-reliance,  and  courage,  which,  after  all,  are 


PHYSICAL  TRAINING  47 

physical  qualities,  as  they  induce  men  to  dare  because  of 
the  consciousness  to  do.  Smartness,  agility,  and  precision 
should  also  be  insisted  upon,  since  they  are  the  physical  ex- 
pression of  that  mental  activity  which  makes  for  self-control, 
self-respect,  and  personal  neatness;  these  combined  spell 
discipline,  which  in  the  military  service  is  the  synonym  for 
success. 

Effect  of  Exercise  on  Heart  and  Lungs. — Every  muscular 
effort  calls  forth  increased  respiratory  action;  this  is  due  to 
the  fact  that  upon  the  respiratory  system  devolves  the  duty 
to  supply  the  blood  with  oxygen  for  the  repair  of  the  bodily 
waste  resulting  from  such  activities.  With  increased  respira- 
tion the  heart  action  is  accelerated,  thus  augmenting  the 
amount  of  blood  passing  through  the  lungs,  where,  in  the 
maintenance  of  the  functional  balance,  carbonic  acid  is 
given  out  and  oxygen  taken  in.  The  respiratory  and  circu- 
latory systems  are  so  closely  related  from  the  view-point  of 
physical  training  that  it  is  difficult  to  divorce  them.  Exercise 
is  a  powerful  stimulant  to  the  heart,  and,  since  this  organ  is  a 
muscle,  it  grows  in  strength  in  proportion  as  the  body  grows, 
and  declines  in  proportion  as  the  muscular  system  is  allowed 
to  decline.  As  it  is  so  closely  concerned  with  every  effort  and 
so  vital  to  well-being,  it  becomes  the  organ  with  which  phys- 
ical instructors  should  most  concern  themselves.  By  judi- 
cious exercise  the  heart  may  be  developed  until  it  is  capable 
of  responding  to  tasks  that  would  result  disastrously  without 
this  preparation.  The  greatest  danger  to  the  structure  of 
the  heart  lies  in  the  strain  laid  upon  it  by  long-continued  and 
excessive  muscular  efforts,  especially  of  the  legs  and  arms. 


48  MILITARY  HYGIENE 

Thus,  running  at  a  great  rate  of  speed  or  for  a  long  period; 
excessive  use  of  the  arms  in  the  accomplishment  of  difficult 
gymnastic  feats  that  require  long-sustained  exertion;  rowing 
until  the  point  of  collapse  is  reached;  wrestling  and  kindred 
contests  that  unduly  tax  the  powers  of  endurance,  should  be 
avoided  by  all  except  those  of  superior  strength  and  endur- 
ance. When  it  is  a  question  of  the  ability  of  the  heart  to  cope 
successfully  with  the  strain  that  is  intended  to  be  placed  upon 
it,  it  is  always  well  to  err  upon  the  side  of  safety. 

Racial  Attributes  to  be  Considered. — In  determining  upon 
a  method  of  physical  training,  there  are  some  fundamental 
essentials  that  must  be  taken  into  consideration  if  the  fullest 
benefits  are  to  be  derived  from  it.  Frequently  it  has  been 
found  that  a  method  that  has  attained  wonderful  results  in 
one  country  fails  to  produce  like  results  when  adopted  in  toto 
by  another.  Since  the  human  organism  is  practically  identi- 
cal in  all  of  the  countries  that  have  given  this  subject  suffi- 
cient consideration  to  evolve  methods  peculiarly  their  own, 
the  reason  for  this  failure  must  be  sought  in  the  fact  that 
these  particular  methods  were  originated  to  fit  the  racial 
characteristics  of  the  people  for  whom  they  are  intended, 
and  that  their  failure  when  transplanted  must  be  attributed 
to  differences  in  mental  characteristics  and  environment. 
Consequently,  to  be  successful  these  factors  must  be  carefully 
considered  and  recognized ;  the  methods  must  be  fitted  to  the 
race  and  not  the  race  to  the  methods. 

Classes  of  Methods. — The  nature  of  the  employment  of 
the  various  means  of  physical  training,  carefully  grouped  into 
well-defined  methods,  is  determined  by  the  object  it  is  sought 


PHYSICAL  TRAINING  49 

to  accomplish;  hence,  depending  upon  the  particular  object- 
ive, such  training  has  been  divided  into  the  following  classes : 

A.  Hygienic,  whose  object  is  the  maintenance  of  general 
health. 

B.  Educational,  the  intent  of  which  is  not  only  hygienic, 
but  also  concerns  itself  with  growth,  development,  the  edu- 
cation of  all  the  physical  attributes  in  general,  and  the  instill- 
ing of  a  thorough  appreciation  of  the  benefits  accruing  from 
the  wholesome  practice  of  regulated  bodily  activity. 

C.  Medical,  or  remedial,  whose  purpose  is  the  restoration 
of  health  or  the  correction  of  physical  defects. 

D.  Military,  which  concerns  itself  entirely  with  the  train- 
ing of  men  for  military  purposes. 

Military  Methods. — It  is  only  with  the  last  named  that 
we  shall  deal  here.  From  the  complexity  of  the  objects  that 
the  physical  training  of  the  soldier  endeavors  to  realize,  as 
enumerated  heretofore,  it  might  appear  that  the  methods 
employed  must  be  very  diversified,  complex,  and  wide  in 
scope,  but  the  contrary  is  true.  It  is  no  longer  considered 
necessary  to  limit  the  means  of  a  soldier's  training  almost 
entirely  to  those  of  an  antagonistic  nature  in  order  to  develop 
his  combative  qualities.  The  tendency  is  to  simplify  his 
training  as  much  as  possible ;  to  use  his  weapon  and  the  nat- 
ural facilities  available ;  and  to  employ  only  the  simplest  of 
gymnastic  appliances  as  aids. 

Instruction  Material. — The  following  instruction  material, 
properly  applied,  is  ample  to  train  men  thoroughly  and  effect- 
ively and  to  keep  them  in  excellent  physical  condition  at  all 
times: 

4 


50  MILITARY  HYGIENE 

1.  Setting-up  exercises. 

2.  Marching,  double  timing,  and  running. 

3.  Rifle  and  sabre  exercises. 

4.  Climbing. 

5.  Jumping  and  vaulting. 

6.  Applied  gymnastics;  apparatus. 

7.  Gymnastic  contests. 

8.  Athletics  and  games. 

9.  Swimming. 

Setting-up  Exercises. — The  setting-up  exercises  are  the 
foundation  upon  which  every  well-organized  method  in 
military  training  must  be  founded.  They  require  no  appli- 
ances of  any  description,  and  can,  therefore,  be  practised 
anywhere,  out-of-doors  or  in  the  most  restricted  space,  hy- 
gienic conditions  being  the  only  adjunct  necessary  to  their 
success.  By  their  means  a  more  effective  all-round  develop- 
ment is  made  possible  than  by  any  other  method.  Muscular 
strength  is  developed  and  increased  by  them,  and,  since  it 
is  possible  to  bring  any  portion  of  the  body  into  action,  they 
are  capable  of  imparting  vigor  and  tone  to  the  vital  organs. 
By  employing  large  muscle  areas  or  by  increasing  the  demands 
upon  any  one  part,  endurance  is  developed,  while  poise, 
dexterity,  agility,  and  general  co-ordination  are  promoted  in 
a  very  high  degree  by  the  employment  of  movements  that 
call  for  nerve  control  rather  than  for  muscular  exertion. 
The  setting-up  exercises  should  always  precede  the  more 
strenuous  forms  of  exercise,  as  they  prepare  the  body  for  the 
greater  exertion  these  forms  demand. 

Quick  Time. — Marching  in  quick  time,  without  equip- 


PHYSICAL  TRAINING  51 

ment  and  for  short  duration,  has  little  value  as  a  develop- 
mental exercise,  its  object  under  ordinary  conditions  being  the 
education  of  the  soldier  in  proper  poise,  carriage,  and  gait. 
It  is  only  when  taken  in  connection  with  arm  or  leg  exercises, 
with  equipment  or  for  long  periods,  that  marching  can  be 
considered  as  a  means  to  development.  The  benefits  to  the 
muscular,  respiratory,  and  circulatory  systems  under  such 
circumstances  depend  upon  the  degree  of  severity  of  the 
movements  performed. 

Double  timing  has  for  its  purpose  the  quick  advancement 
of  troops  with  the  least  possible  expenditure  of  physical  effort : 
this  is  accomplished  by  diminishing  leg  motions,  thereby  cur- 
tailing the  height  of  the  thrust  of  the  body  when  neither  foot 
is  upon  the  ground.  Its  greatest  importance  lies  in  teach- 
ing the  men  how  to  husband  and  conserve  their  muscular 
strength  and  how  to  control  the  respiration  to  the  best 
advantage. 

Running  is  the  swiftest  and  physically  the  most  expensive 
means  of  progression.  It  differs  from  double  timing  in  the 
increased  number  and  exaggerated  character  of  the  leg 
movements;  in  the  increased  force  with  which  the  body  is 
thrust  from  the  ground;  and  in  the  increased  demand  upon 
the  muscles  of  the  trunk  and  neck,  which,  by  their  contrac- 
tion, give  to  the  head  and  body  that  degree  of  immobility 
without  which  speed  is  impossible.  It  is  almost  entirely  this 
contraction,  which  interferes  seriously  with  regular  respira- 
tion and  which  in  turn  affects  the  heart  action,  to  which  the 
breathlessness  noticed  in  runners  is  due.  Thus,  while  run- 
ning will  develop  endurance  as  well  as  lung,  heart,  and  leg 


52  MILITARY  HYGIENE 

power  as  no  other  form  of  exercise  will,  it  does  so  with  the 
ever-present  liability  to  injury  when  carried  to  excess. 

Rifle  and  Sabre. — Rifle  exercises  are  extremely  valuable 
in  developing  dexterity  in  the  use  of  the  weapon,  and,  on 
account  of  the  weight  of  the  piece,  they  develop  the  muscles 
of  the  back,  arms,  shoulders,  and  upper  chest  in  a  marked 
degree.  When  taken  in  connection  with  leg  and  trunk  move- 
ments they  are  excellent  aids  in  the  development  of  organic 
vigor,  especially  of  the  heart  and  lungs,  for  those  who  possess 
the  necessary  strength  to  wield  the  piece  to  advantage. 

For  the  mounted  service  the  sabre,  used  ambidextrously, 
may  be  substituted  for  the  rifle. 

Climbing  may  be  regarded  as  an  applied  exercise,  since 
it  prepares  the  men  for  the  exigencies  of  the  service  by  teach- 
ing them  successfully  to  overcome  obstacles  that  may  be 
presented  to  them  in  the  field.  Climbing  with  hands  and 
legs  brings  into  action  almost  every  muscle  of  the  body,  and, 
when  the  climbing  is  done  with  the  hands  alone  or  at  a  rapid 
rate  with  both  hands  and  legs,  it  has  a  very  marked  effect 
upon  the  heart  and  lungs. 

Jumping  and  vaulting  are,  essentially,  applied  forms  of 
exercise;  they  are  invaluable  to  a  soldier,  who,  in  the  field, 
is  constantly  being  confronted  by  obstacles  which  he  must 
negotiate  either  by  jumping  or  vaulting.  Jumping,  besides 
being  a  potent  leg  developer,  is  also  a  great  factor  in  the 
development  of  agility  and  muscular  co-ordination,  and,  when 
taken  from  a  considerable  height,  of  self-reliance.  Vaulting 
develops  the  muscles  of  the  arms  and  legs,  and,  since  these 
members  must  work  in  unison,  the  sense  of  co-ordination  be- 


PHYSICAL  TRAINING  53 

tween  the  two  is  fostered  in  a  high  degree.  Vaulting  also 
promotes  self-reliance  and  fearlessness. 

Applied  gymnastics  are  those  forms  of  movements  in 
which  the  soldier  is  instructed  to  overcome  and  surmount 
obstacles  by  means  of  his  own  exertions.  These  obstacles 
may  be  gymnastic  appliances,  such  as  horses,  vaulting  bars, 
and  horizontal  bars,  or  they  may  be  natural  objects,  as  fences, 
walls,  and  ditches.  The  purpose  of  these  exercises  is  the 
muscular  development  of  the  body  in  general  and  of  the  arms 
and  legs  in  particular,  with  special  reference  to  strength, 
agility,  dexterity,  and  confidence,  in  order  to  enable  the  sol- 
dier to  accomplish  these  efforts  with  the  least  amount  of 
physical  exertion. 

Gymnastic  contests  consist  of  the  simpler  forms  of 
antagonistic  exercises  in  which  the  contestants  are  pitted 
against  each  other.  Their  aim  is  the  promotion  of  quickness 
of  thought,  perception  and  action,  with  definiteness  of  pur- 
pose. They  require  considerable  skill  and  muscular  effort, 
and  for  that  reason  make  for  endurance  and  vigor  by  affecting 
the  vital  organs  in  a  more  than  moderate  degree. 

Athletics. — The  value  of  athletic  games  to  the  military 
service  is  dependent  upon  the  effect  these  have  upon  the  mass 
and  not  upon  the  individual  few.  Training  in  these,  in  order 
to  meet  the  requirements  of  the  service,  should  have  nothing 
in  common  with  competitive  athletics,  but  should  be  broad 
enough  to  reach  out  and  include  the  development  of  every 
man,  to  the  extent  of  his  capabilities,  in  those  branches  of 
athletics  whose  utility  to  the  service  is  unquestioned.  In 
other  words,  they  should  have  an  applicable  value,  be  educa- 


54  MILITARY  HYGIENE 

tional,  recreative,  and  not  spectacular,  for  it  is  the  ability 
of  the  average  of  the  mass  that  determines  the  efficiency  of 
the  whole. 

In  order  to  stimulate  interest  the  men  should  be  grouped 
into  classes  upon  the  basis  of  ability,  and  promoted  or  de- 
moted as  their  progress  or  lack  of  it  warrants. 

Properly  conducted  athletics  can  be  made  a  very  decided 
factor  in  the  scheme  for  the  training  of  the  soldier,  since  they 
embody  all  those  qualities  which,  from  time  immemorial, 
have  been  considered  so  essential  in  the  soldier.  They  re- 
quire an  abundance  of  muscular  and  nervous  energy,  endu- 
rance, hardihood,  skill,  courage,  and  reliance,  arid,  as  these 
qualities  cannot  be  developed  in  a  very  high  degree  without 
a  strict  adherence  to  the  laws  of  hygienic  living,  excesses  of 
any  description  must  be  avoided  by  those  wishing  to  excel. 
Athletics  and  athletic  games  are  thus  powerful  and  voluntary 
aids  to  discipline. 

Swimming  is  of  vital  importance  to  all  who  are  concerned 
with  the  service,  and  proficiency  therein  should  be  required  of 
all,  officers  and  men.  Aside  from  its  usefulness,  it  is  one 
of  the  very  best  means  to  attain  all-round  development. 
The  combinations  and  the  character  of  the  movements  em- 
ployed in  swimming  bring  almost  every  group  of  muscles  into 
action  in  a  manner  that  is  impossible  in  any  other  form  of 
physical  exercise.  It  adds  materially  to  the  powers  of  res- 
piration, thereby  increasing  the  size  of  the  thorax  and  giving 
a  decided  tone  to  the  lungs  and  heart.  Not  less  important 
is  its  effect  upon  the  moral  qualities,  confidence,  reliance, 


PHYSICAL  TRAINING  55 

judgment,  and  courage,  all  of  which  are  promoted  to  a  degree 
not  equalled  by  any  other  means. 

Factors  to  be  Considered. — In  employing  the  various 
means  described  above  and  embodying  them  into  a  defined 
method,  the  following  factors  must  be  considered: 

(a)  The  condition  and  physical  aptitude  of  the  men. 

(6)  The  facilities. 

(c)  The  time. 

(d)  The  instruction  material. 

Condition  and  Aptitude. — The  question  of  physical  apti- 
tude and  general  condition  of  the  men  is  a  very  important 
one,  and  should  always  determine  the  nature  and  extent  of 
the  task  expected  of  them.  Never,  except  in  the  more  ad- 
vanced classes,  should  the  work  be  made  the  determining 
factor.  In  general,  it  is  advisable  to  divide  the  men  into 
three  classes,  viz.,  the  recruit  class,  the  intermediate  class, 
and  the  trained  soldier  class.  The  work  for  each  class  should 
fit  the  capabilities  of  the  members  of  the  respective  classes 
and  be  arranged  progressively. 

Facilities  will  necessarily  influence  the  nature  and  extent 
of  the  work,  but  even  with  the  most  meagre  ones  an  enter- 
prising instructor  need  not  despair  of  results,  since  the  in- 
struction material  is  applicable  to  all  conditions. 

Time  is  an  important  factor,  and  no  method  can  be  suc- 
cessful unless  specified  periods  are  arranged  for  in  advance. 
During  suspension  of  drills,  at  least  five  periods  a  week,  of 
from  thirty  to  forty-five  minutes  each,  should  be  devoted  to 
this  training;  during  the  drill  period  ten  or  fifteen  minutes 
per  day  should  be  assigned  to  the  setting-up  exercises. 


56  MILITARY  HYGIENE 

When  possible,  these  physical  training  drills  should  be  held 
in  the  morning,  about  two  hours  after  breakfast;  at  no  time 
should  they  be  held  immediately  after  or  before  a  meal. 

Use  of  Material. — The  proper  use  of  the  instruction  ma- 
terial is  undoubtedly  the  most  important  factor,  for  success 
is  dependent  upon  its  proper  selection  and  application. 
Every  exercise  has  a  function  peculiarly  its  own,  and  it  is 
the  sum  of  these  exercises  that  constitutes  the  success  of  the 
method.  When  possible,  every  lesson  should  be  planned 
to  embrace  (a)  setting-up  exercises  that  call  into  action  all 
parts  of  the  body;  (6)  applied  gymnastics;  and  (c)  exercises 
that  develop  co-ordination  and  skill,  such  as  jumping  and 
vaulting.  Exercises  that  employ  the  extensor  muscles  chiefly 
should  be  followed  by  others  that  employ  the  flexors;  and 
those  requiring  a  considerable  amount  of  exertion  should  be 
succeeded  by  those  in  which  exertion  is  reduced  to  a  minimum. 
Exercises  for  one  part  of  the  body  should  be  alternated  with 
those  for  another:  thus,  arm  movements  should  be  followed 
by  leg  movements,  and  these,  in  turn,  by  others  for  the  trunk, 
shoulder,  or  neck.  The  work  must  be  conducted  so  that  the 
men  are  developed  harmoniously,  and  any  tendency  to  de- 
velop one  part  or  one  side  at  the  expense  of  the  other  must 
be  avoided.  All  exercises  should  be  performed  energetically, 
and  precision  and  accuracy  should  always  be  insisted  upon; 
thus,  while  strength  and  endurance  are  being  generated, 
activity,  agility,  and  smartness  are  also  promoted.  Exer- 
cises should  be  selected  that  require  activity  and  agility  rather 
than  those  that  require  strength  only.  It  should  always  be 
kept  in  sight  that  the  exercises  are,  as  a  rule,  the  means  and 


PHYSICAL  TRAINING  57 

not  the  end,  and  if  there  is  any  doubt  as  to  the  amount  of 
strain  produced  by  an  exercise,  it  should  be  modified  in  char- 
acter or  shortened  in  time.  Underdoing  is  rectifiable;  over- 
doing often  is  not.  The  object  should  be,  not  the  production 
of  experts,  but  the  development  of  physically  sound  men 
by  means  in  which  the  chance  of  bodily  injury  from  over- 
exertion  or  strain  is  reduced  to  a  minimum. 

Fatigue  and  Breathlessness. — In  order  to  make  the  drills 
attractive  the  work  should  be  made  as  varied  as  possible, 
for  the  mind  exerts  more  influence  over  the  body  than  do  all 
the  gymnastic  paraphernalia.  The  men  should  never  be 
exercised  to  the  point  of  exhaustion;  if  there  is  any  tendency 
to  respiratory  embarrassment,  the  exercise  should  be  ter- 
minated and  not  resumed  again  until  the  men  have  recovered 
their  breath.  Proper  breathing  should  always  be  insisted 
upon;  ' 'holding  the  breath/'  or  breathing  only  when  it  can 
no  longer  be  held,  is  injurious.  Every  exercise  should,  if 
possible,  be  accompanied  by  an  uninterrupted  act  of  respira- 
tion (inspiration  and  expiration)  depending  upon  the  nature 
of  the  exercise.  Inhalation  should  always  accompany  that 
part  of  an  exercise  which  tends  to  extend  and  elevate  the  tho- 
rax, while  exhalation  accompanies  that  part  of  an  exercise 
that  exerts  pressure  against  the  chest  walls.  Excessive  and 
frequent  breathlessness  is  not  infrequently  the  cause  of 
serious  injury  to  the  heart,  to  the  lungs,  or  to  both  these 
organs;  therefore,  in  cases  where  exercises  produce  that 
condition,  it  is  advisable  to  recommend  absolute  rest  or  to 
order  such  slow  movements  as  will  tend  to  relieve  the  op- 
pressed and  taxed  organs.  Leg  exercises,  slowly  executed, 


58  MILITARY  HYGIENE 

will  equalize  the  circulation  by  drawing  the  blood  from  the 
trunk  to  the  lower  extremities,  thereby  lessening  the  heart's 
action  and  quieting  the  respiration. 

Avoidance  of  Chill. — Muscular  action  produces  an  unusual 
amount  of  bodily  heat,  which  should  be  lost  gradually,  other- 
wise the  body  will  become  chilled;  it  is  advisable,  therefore, 
to  add  some  wrap  after  exercising  and  to  be  well  protected 
when  leaving  the  gymnasium  or  drill  ground.  The  taking 
of  cold  baths  when  the  body  is  heated  (as  is  the  case  after 
violent  exercise)  should  be  discouraged.  In  individual  cases 
such  baths  may  appear  beneficial;  in  a  majority  of  cases, 
however,  they  cannot  be  used  with  impunity.  Tepid  baths 
are  recommended.  When  impossible  to  bathe,  the  flannels 
worn  while  exercising  should  be  stripped  off,  one  garment  at  a 
time,  the  body  sponged  with  tepid  water,  and  then  rubbed 
thoroughly  with  coarse  towels.  Flannel  is  the  best  material 
to  wear  next  to  the  skin  while  exercising,  as  it  absorbs  the 
moisture  of  the  body,  protects  it  from  drafts,  and  excites  the 
skin  mildly.  The  men  may  wear  the  ordinary  athletic  cos- 
tume when  weather  conditions  permit. 


CHAPTER  V 
PREVENTABLE  DISEASES 

IN  the  first  place,  the  fact  must  be  recognized  that  there 
are  no  diseases  peculiar  to  soldiers.  There  is  not,  by  reason 
of  their  occupation  or  mode  of  life,  any  abnormal  physical 
condition  engendered  which  has  not  its  counterpart  among 
civilians.  On  the  other  hand,  there  are  certain  departures 
from  a  state  of  health  to  which  soldiers  are  especially  liable 
because  of  their  work  and  environment.  Newly  raised 
troops  and  recruits  generally  have  the  highest  disease  rates. 
Old  soldiers  are  inured  to  service  and  have  learned  how  to 
care  for  themselves. 

Dependency  of  Soldiers. — "The  men  who  compose  an 
army  are  drawn  from  civil  life,  in  which  each  individual  has, 
to  a  greater  or  less  extent,  independent  control  of  his  time, 
choice  of  occupation,  selection  of  food  and  dwelling  place, 
and  general  sanitary  care.  After^  enlistment,  soldiers  lose 
most  of  this  independence;  they  are  housed,  clothed,  fed,  and 
exercised  under  regulations  which  it  is  beyond  their  power  to 
amend;  they  are  moved  from  one  point  to  another,  differing 
perhaps  very  widely  in  climatic  and  other  conditions,  under 
orders  which  they  may  not  presume  to  question;  their  hours 
for  sleep,  meals,  work,  and  recreation  are  fixed  for  them 
without  consultation  with  them  or  without  regard  to  indi- 
vidual .or  communal  preference"  (Harrington). 

59 


60  MILITARY  HYGIENE 

Inexperienced  Soldiers. — In  our  military  system  the  abso- 
lute dependence  on  the  will  or  neglect  of  a  superior  is  especi- 
ally prone  to  result  in  disease  conditions,  because  of  the  ignor- 
ance and  inexperience  of  militia  and  volunteers  suddenly 
called  into  active  service.  The  officers  have  little  or  no  knowl- 
edge of  the  care  of  troops,  while  the  men  exhibit  a  reckless- 
ness and  disregard  for  the  laws  of  health  peculiarly  national. 
The  American  volunteer,  unless  firmly  commanded,  displays 
the  utmost  indifference  to  the  ordinary  rules  of  decency.  He 
deposits  his  excrement  where  he  happens  to  be;  he  drinks  of 
any  liquid  he  encounters  which  may  be  dignified  by  the  name 
of  water;  he  throws  his  wastes  indiscriminately  upon  the 
camp  ground,  heedless  of  the  fact  that  putrefactive  changes 
will  shortly  make  them  offensive;  he  gleefully  seeks  oppor- 
tunities for  alcoholic  and  sexual  excesses;  and,  in  defense  of 
his  heaven-born  liberties,  he  often  declines  to  mend  his 
ways  because  he  enlisted  to  fight  and  not  to  perform  menial 
occupations.  The  necessity  on  the  part  of  line  officers  for 
familiarity  with  the  preventable  diseases  to  which  the  soldier 
is  liable  and  with  the  fundamental  sanitary  principles  neces- 
sary for  their  prevention  thus  becomes  apparent. 

Infection  and  Immunity. — Nearly  all  the  so-called  prevent- 
able diseases  (and  especially  those  of  an  epidemic  character) 
are  infectious;  that  is  to  say,  they  are  caused  by  a  specific 
germ  or  virus  which  is  capable  of  being  transmitted  from  one 
person  to  another.  Germs  are  extremely  minute  living  bodies, 
most  of  them  being  tiny  vegetables,  though  some  are  micro- 
scopic animals.  The  vegetable  germs  are  known  as  bacteria, 
but  are  classed  as  micrococci,  bacilli,  or  spirilla,  in  accordance 


PREVENTABLE  DISEASES  61 

with  their  shape.    Thus,  a  coccus  is  round;  a  bacillus,  rod 
shaped;  a  spirillum,   curved.     Animal  germs  which  cause 

A.  B. 


Fig.  1. — Disease  germs  of  vegetable  origin.  Forms  of  bacteria:  A, 
Cocci  (or  micrococci);  B,  bacilli;  C,  spirilla.  Bacteria  are  extremely 
small,  some  being  not  more  than  gOOQ()  inch  long. 

disease  belong  to  the  lowest  class  of  the  animal  kingdom,  the 
so-called  protozoa.  A  protozoon  is  made  up  of  a  single  cell. 
Not  all  persons  are  susceptible  to  the  attacks  of  disease  germs. 


A  B 

Fig.  2. — Disease  germs  of  animal  origin.  A,  Malaria:  the  germs  are 
the  darker  objects  seen  inside  red  blood-corpuscles.  The  corpuscles 
are  about  -^"oVo"  inch  in  diameter.  B,  Amebic  dysentery:  the  round  spots 
within  the  amebse  are  blood-corpuscles  which  the  former  have  captured. 
(From  Bulletin  No.  1,  Office  of  the  Surgeon  General,  United  States 
Army,  1913.) 

Some  individuals  possess  a  natural  immunity  to  one  or  more 
diseases,  while  others  may  become  immune  through  an  attack 
of  the  disease  or  by  vaccination  against  it. 


62  MILITARY  HYGIENE 

The  Prime  Source  of  Infection. — In  the  consideration  of 
the  subject  of  preventable  disease,  the  one  fact  that  over- 
shadows all  others  is  that  the  prime  source  of  infection  is  the 
sick  man.  Air,  food,  water,  insects  are  simply  distributing 
agents.  Therefore,  the  sick  and  the  well  must  be  separated, 
and  any  body  wastes  which  may  contain  the  infectious  agent 
must  be  rendered  harmless.  It  should  be  understood  that 
all  nature  swarms  with  minute  forms  of  life,  though  compar- 
atively few  of  these  will  produce  disease.  Simple  methods 
often  suffice  to  destroy  disease  germs.  Such  methods  include 
the  use  of  physical  agents  (notably,  heat)  and  chemicals.  A 
chemical  which  kills  the  germs  is  known  as  a  disinfectant. 
If  its  strength  is  not  sufficient  to  kill,  but  is  yet  enough  to 
retard  microbic  growth  and  activities,  the  agent  is  called 
an  antiseptic.  Sterilization  is  a  term  employed  to  indicate  the 
complete  destruction  of  all  microscopic  forms  of  life  which 
may  be  contained  in  any  substance. 

Venereal  Disease. — Of  all  the  ills  from  which  the  soldier 
suffers,  those  consequent  upon  venery  affect  his  efficiency  to 
the  greatest  extent.  Our  army  is  made  up  mainly  of  young, 
unmarried  men,  freed  from  the  moral  restraints  of  home, 
often  without  opportunity  for  association  with  decent  women 
and  susceptible  to  the  suggestions  of  the  vicious.  There 
must  be  some  outlet  for  their  surplus  energies.  They  visit 
places  of  amusement,  many  of  which  are  maintained  with  the 
sole  object  of  pandering  to  vice,  where  strong  liquor  and  the 
advances  of  lewd  women  combine  to  break  down  such  moral 
defenses  as  they  may  possess.  Unless  prevented  by  legal 
enactment  the  lowest  kinds  of  ""dives"  cluster  round  the 


PREVENTABLE  DISEASES  63 

entrances  to  army  posts.  The  soldier  has  a  right  to  his  amuse- 
ments and  we  must  strive  to  furnish  such  as  will  attract  him 
more  than  evil  resorts;  to  secure  the  passage  of  laws  prevent- 
ing the  establishment  of  low  brothels  at  our  gates;  and  to 
build  up  the  moral  stamina  of  our  men  by  education. 

Statistics  show  that  at  least  a  third  of  all  women  who  give 
their  bodies  for  immoral  purposes  are  suffering  from  some 
form  of  venereal  disease.  This  includes  not  merely  the  pro- 
fessional prostitute,  but  the  chorus  girl,  "saleslady,"  or  mill 
hand,  who,  to  satisfy  her  love  for  finery  or  for  other  reasons, 
may  eke  out  a  scanty  income  by  occasional  lapses  from 
virtue.  It  is  a  medical  axiom  that  every  prostitute  becomes 
infected  with  syphilis  inside  of  two  or  three  years.  It  is, 
therefore,  easy  to  see  that  the  risks  of  contagion  are  very 
great.. 

This  subject  will  be  discussed  more  at  length  in  a  later 

chapter. 

Typhoid  Fever 

Typhoid  fever  (or  enteric,  as  the  English  call  it)  has  for 
many  years  been  known  as  "the  scourge  of  armies."  In  our 
Civil  War  the  Union  Army  had  over  80,000  cases  recognized 
as  such,  and  there  were  probably  as  many  more  which,  be- 
cause of  imperfect  means  of  diagnosis,  were  thought  to  be 
malaria  and  other  affections. 

War  of  1870. — The  Germans,  in  the  war  with  France  in 
1870,  had  over  73,000  cases  and  nearly  7000  deaths,  although 
active  hostilities  lasted  but  six  months. 

Boer  War. — The  British  Army  in  South  Africa,  while 
fighting  with  the  Boers,  had  57,000  cases  and  8000  deaths. 


64  MILITARY  HYGIENE 

War  of  1898. — In  our  war  with  Spain  we  had  20,738 
cases,  with  1580  deaths,  among  108,000  me^  all  occurring 
within  three  and  a  half  months;  1  man  in  every  6  had  the 
disease,  while  this  proportion  was  increased  to  1  in  5  among 
those  regiments  which  never  left  the  United  States.  Typhoid 
fever  canned  nine-tenths  of  all  deaths  occurring  among  troops 
encamped  in  the  United  States  in  1898. 

Such  instances  might  be  multiplied  indefinitely,  but  enough 
has  been  said  to  show  what  an  immense  amount  of  sickness 
and  military  inefficiency — to  say  nothing  of  the  suffering  and 
death  of  individuals,  with  economic  loss — this  dreaded  disease 
causes. 

In  Civil  Communities. — Typhoid  fever  exists  constantly  in 
civil  communities,  and  it  is  safe  to  say  that  1000  men  of 
military  age  could  not  be  assembled  anywhere  in  this  country 
without  at  least  one  man  bringing  the  disease  along  with  him. 
It  is  estimated  that  in  the  United  States  we  have  annually 
about  400,000  cases  of  typhoid  fever,  with  approximately 
40,000  deaths.  This  means  a  death  for  every  10  persons 
attacked,  and  many  who  do  not  die  never  recover  completely, 
but  become  chronic  invalids  or  are  crippled  in  various  ways. 
In  any  event,  a  man  will  be  disabled  by  an  attack  for  at  least 
three  months,  as  convalescence  is  slow  and  protracted. 
Young  men  are  peculiarly  liable  to  the  disease,  which  by  pref- 
erence attacks  vigorous  males  between  the  ages  of  fifteen 
and  forty.  However,  cases  are  by  no  means  infrequent  in 
later  life. 

Cause. — Typhoid  fever  is  due  to  a  tiny  little  vegetable 
germ — or,  rather,  to  aggregations  of  billions  and  trillions 


PREVENTABLE  DISEASES  65 

of  such  germs — to  which  is  given  the  name  typhoid  bacillus. 
When  looked  at  under  the  microscope  these  germs,  if  sus- 
pended in  a  drop  of  water,  are  seen  to  have  very  active 
motion.  They  multiply  with  enormous  rapidity,  so  that 
under  favorable  conditions  a  single  germ  may  develop  into 
millions  within  twenty-four  hours. 

How  Spread. — Typhoid  bacilli  find  the  most  favorable  soil 
for  their  growth  and  increase  in  the  bowels  of  human  beings'; 
they  are  usually  found  also  in  the  urine  of  infected  individuals. 
The  disease  is  spread,  therefore,  by  the  discharges  of  such  in- 
dividuals gaining  access  to  the  intestinal  canals  of  others 
through  swallowing  substances  contaminated  with  the  germ. 
This  may  happen  directly  by  contact  with  a  diseased  person 
or  indirectly  through  infected  water,  milk,  uncooked  fruit 
and  vegetables,  dust,  flies,  soiled  hands,  garments,  bedding, 
or  tentage. 

If  we  had  a  perfect  method  of  disposal  of  these  waste  prod- 
ucts of  the  body,  it  would  not  be  long  before  typhoid  fever 
would  cease  to  appear  in  epidemic  form,  and  only  an  occa- 
sional case  would  be  encountered  as  the  result  of  direct  con- 
tact with  an  infected  individual.  But,  under  the  imperfect 
sanitary  conditions  of  modern  existence,  it  will  be  a  long  time 
before  this  is  realized,  and  in  the  meanwhile  we  must  employ 
such  measures  as  will  reduce  to  a  minimum  the  risks  of  con- 
tact with  infectious  material. 

Army  Epidemics. — Typhoid  fever  is  more  likely  to  become 
epidemic  in  military  than  in  civil  life  because  of  the  greater 
difficulty  in  disposing  of  wastes,  and  the  close  crowding  and 

intimate  contact  of  young  men  under  the  conditions  of  camp 
5 


66  MILITARY  HYGIENE 

and  barrack  life.  A  man  affected  with  typhoid  may  scatter 
the  germs  of  the  disease  widely  before  its  existence  is  recog- 
nized in  himself,  since  it  frequently  happens  that  mild  cases 
are  not  detected  for  a  week  or  two  from  their  onset.  More- 
over, 3  or  4  persons  in  every  100  who  have  recovered  from 
attacks  continue  to  breed  the  germs  in  their  bodies  and  to 
discharge  them  with  their  excretions.  We  call  such  chronic- 
ally infected  individuals  carriers.  Such  a  man,  by  defe- 
cating in  the  nearest  brush,  stepping  just  outside  his  tent  at 
night  to  urinate,  or  failing  to  cover  his  discharges  in  the  sink 
(whereby  flies  may  have  access  to  them,  to  convey  the  filth 
to  food  in  nearby  kitchens  a  little  later)  may  be  sowing  the 
seeds  of  the  scourge  broadcast.  Each  man  who  thus  offends 
seems  to  think  he  is  the  only  one  who  does  such  a  trick  and 
so  it  won't  do  any  harm.  Unfortunately,  many  of  his  com- 
rades are  looking  at  the  matter  from  the  same  point  of  view. 
And  flies  are  not  necessarily  the  agents  in  this  matter.  Let 
us  again  assume  one  infected  individual  in  camp.  His 
habits  as  to  cleanliness  may  be  bad  or  his  opportunities 
therefor  poor.  At  any  rate,  his  hands  are  sure  to  be  soiled 
with  infectious  material,  which  he  transfers  to  everything  he 
touches — clothing,  bedding,  towel,  the  cigars  or  matches  he 
proffers  to  a  comrade,  and  even  the  food  of  others  which  he 
handles — for  he  may  be  company  cook  or  cook's  police.  His 
saliva  is  infectious  and  he  fouls  the  common  drinking  cup  or 
a  pipe  which  another  may  use.  Or,  again,  a  soldier's  shoes 
may  be  soiled  with  the  filth  deposited  upon  the  ground  by 
a  careless  comrade.  This  material  is  carried  about  the  camp 
and  into  tents,  and,  since  the  typhoid  bacillus  may  live  for  a 


PREVENTABLE  DISEASES  67 

time  in  the  earth,  a  puff  of  wind  or  a  friendly  scuffle  whirls 
the  infected  dust  in  the  air,  whence  it  is  likely  to  be  inhaled 
or  blown  upon  food  and  thus  swallowed.  By  such  means 
not  one  but  dozens  of  men  are  infected,  and  with  each  new 
case  the  risks  grow  in  geometric  progression.  In  the  multi- 
tude of  cases  during  the  Spanish-American  War,  impure 
water  played  little  or  no  part.  The  three  factors  almost 
wholly  responsible  for  these  cases  were  uncovered  excreta, 
flies  attracted  thereby,  and  personal  contact  with  infected 
individuals. 

Prevention. — Now,  what  is  the  "ounce  of  prevention" 
in  this  case?  It  consists,  first,  in  the  preliminary  antity- 
phoid vaccination  of  men  believed  to  be  susceptible;  second, 
in  a  campaign  of  education  (which  must  be  shared  by  line 
and  medical  officers  alike)  in  the  facts  just  related;  third,  in 
the  protection  of  the  water-supply;  fourth,  in  the  systematic 
and  thorough  disposal  of  excreta  and  organic  wastes  generally; 
and  fifth,  in  sharp  punishment  for  violations  of  sanitary  regu- 
lations. 

Antityphoid  Vaccination. — In  antityphoid  injections  we 
now  have  a  method  of  protection  against  this  disease  which 
is  quite  as  efficacious  as  is  vaccination  against  small-pox. 
It  is  well  known  that  an  attack  of  typhoid  usually  protects 
a  man  against  a  subsequent  attack.  Only  1  case  in  143  has 
typhoid  a  second  time,  and  the  method  of  protection  referred 
to  is  found  to  confer  immunity  in  a  similar  way  and,  it  is 
thought,  to  an  equal  degree. 

Its  History. — The  development  of  the  method  is  interesting 
and  its  history  will  not  be  amiss.  Acting  upon  the  knowledge, 


68  MILITARY  HYGIENE 

heretofore  mentioned,  that  an  attack  of  typhoid  protects 
against  the  disease  subsequently  by  causing  the  formation  in 
the  blood  of  substances  which  are  antidotal  to  the  typhoid 
bacillus,  an  English  investigator  began,  a  few  years  ago,  to 
experiment  in  the  artificial  production  of  these  substances. 
He  found  that  when  he  killed  bacilli  by  subjecting  them  to 
heat,  and  then  injected  a  quantity  of  them  under  the  skin  of 
an  animal  (in  this  case  the  guinea-pig)  which  is  susceptible 
to  the  disease,  he  produced  in  the  blood  of  this  animal  exactly 
such  substances — called  antibodies  for  convenience — as  an 
attack  of  typhoid  produces  in  the  blood  of  man.  Here,  then, 
was  his  clue,  which  he  followed  up  by  injecting  killed  bacilli 
under  the  skin  of  some  British  soldiers  going  to  the  Boer  War. 
The  results  were  but  fairly  good,  and  it  was  only  after  some 
years  of  further  experimentation  that  it  was  found  that  not 
enough  antibodies  were  produced  by  a  single  dose  and  that  a 
second  and  even  a  third  injection,  at  intervals  of  about  ten 
days,  was  necessary  to  produce  satisfactory  immunity. 
Since  this  stage  of  knowledge  has  been  reached,  the  British 
and  German  armies  have  tested  the  procedure  (now  known 
as  antityphoid  vaccination),  with  strikingly  good  results. 

Germans. — The  Germans,  in  their  campaign  against  the 
Herreros  in  Southwest  Africa,  1904  to  1907,  cut  their  typhoid 
rate  in  half  by  vaccinating  a  part  of  their  soldiers.  Those 
who,  in  spite  of  the  treatment,  were  attacked  by  the  disease, 
had  mild  cases  which  were  seldom  attended  by  complications. 

British.— In  1908  the  British  vaccinated  about  6000  of 
their  soldiers  in  India  and  maintained  nearly  an  equal  number 
of  unvaccinated  men  under  similar  conditions,  in  order  to 


PREVENTABLE  DISEASES  69 

compare  the  results.  It  was  found  that  seven  times  as  many 
of  the  non-vaccinated  contracted  typhoid  and  that  eleven 
times  as  many  died  of  it.  Moreover,  all  but  4  of  the  vacci- 
nated men  who  contracted  the  disease  received  but  one  dose, 
while  those  4  had  very  mild  attacks.  To  make  the  compar- 
ison of  results  even  more  striking,  it  may  be  said  that  as  many 
of  the  non- vaccinated  died  of  this  fever  as  were  taken  sick 
among  the  vaccinated  individuals. 

United  States. — But  it  is  in  our  own  service  that  the  pro- 
cedure has  been  most  thoroughly  tested  and  its  value  defi- 
nitely proved.  Vaccinations  of  officers  and  men  who  volun- 
teered for  the  purpose  were  commenced  in  1909.  The  results 
were  so  good  that  in  1911  the  procedure  was  made  compul- 
sory for  all  under  forty-five  years  of  age  who  had  never  had 
the  disease.  The  navy  followed  suit,  and  immunization  of 
both  services  is  now  practically  complete.  A  single  instance 
of  the  value  of  this  prophylactic  measure  to  our  service  will 
suffice.  This  takes  the  form  of  a  comparison  between  an 
army  division  in  Florida  during  the  Spanish  War  in  1898  and 
a  division  in  Texas  during  the  border  troubles  of  1911. 
Conditions  as  to  strength  of  command,  climate,  season,  purity 
of  water-supply,  and  duration  of  camp  were  approximately 
equal.  The  disposal  of  wastes  was  much  superior  in  the 
latter  camp,  but  the  complete  immunization  of  the  Texas 
command  by  means  of  the  antityphoid  prophylactic  consti- 
tuted the  conspicuous  difference: 

Cases  of  typhoid 

Mean  (certain  and        Deaths  from 

Year.  strength.  probable).  typhoid. 

1898 10,759       2.693       248 

1911 12,801       2  0 


70  MILITARY  HYGIENE 

Preparation. — The  material  employed  is  prepared  in  the 
Army  Medical  Laboratory  at  Washington,  and,  after  ster- 
ilization by  heat  at  a  moderate  temperature,  a  small  per- 
centage .of  disinfectant  is  added  to  insure  its  keeping  prop- 
erties and  it  is  placed  in  sealed  glass  tubes.  When  a  vac- 
cination is  to  be  made,  the  tip  of  the  glass  tube  is  broken  off, 
the  contents  sucked  up  into  a  hypodermic  syringe,  and  a 
small  amount  injected  under  the  skin  of  the  arm  in  the  situa- 
tion used  for  ordinary  vaccination.  Usually  within  three  or 
four  hours  from  the  time  of  the  injection  the  vaccinated  man 
notices  certain  symptoms  of  the  action  of  the  substance. 
These  are  redness,  swelling,  and  soreness  for  an  inch  or  two 
about  the  site  of  the  injection,  with  perhaps  some  headache, 
backache,  feverishness,  and  a  sick  feeling.  These  symptoms 
vary  in  severity  with  different  individuals,  but  in  many  thou- 
sands of  doses  administered  to  persons  in  our  army,  less  than 
1  per  cent,  have  been  followed  by  anything  like  severe  reac- 
tions, while  less  than  5  per  cent,  show  even  moderate  severity. 
In  two-thirds  of  all  cases  practically  no  reaction  has  been  ob- 
served other  than  a  little  soreness  of  the  arm.  Symptoms 
of  the  usual  reaction  may  best  be  described  by  saying  that 
one  feels  as  if  he  were  coming  down  with  a  cold,  but,  as  re- 
covery follows  quickly,  he  realizes  that  it  was  merely  the 
effects  of  the  vaccine.  This  reaction  lasts  from  four  to  forty- 
eight  hours.  In  most  cases,  if  the  dose  is  administered  in  the 
afternoon,  for  instance,  the  symptoms  are  quite  gone  by  the 
following  morning.  The  discomforts  attendant  upon  immu- 
nization against  this  dread  disease  are,  therefore,  much 
slighter  and  briefer  than  are  those  of  a  successful  vaccination 


PREVENTABLE  DISEASES  71 

against  small-pox  and  infinitely  less  painful  than  a  visit  to 
the  dentist. 

Immunity. — We  do  not  yet  know  how  long  the  immunity 
conferred  in  this  manner  will  persist.  However,  we  find  that 
the  vaccination  produces  in  the  blood  a  greater  quantity  of 
the  so-called  antibodies  than  is  produced  by  an  attack  of 
the  fever.  We  know  that,  as  before  mentioned,  an  attack 
of  the  disease  protects,  as  a  rule,  throughout  life.  The  ex- 
perience of  the  English,  who  have  been  using  the  method 
longer  than  we,  would  seem  to  show  that  men  were  still  pro- 
tected after  the  lapse  of  two  or  three  years.  If  the  immuni- 
zation lasts  no  longer  than  three  years,  this  period  would  still 
be  sufficient  for  us  as  military  men,  since  no  war  in  the 
present  age  is  likely  to  last  so  long.  Then,  too,  just  as  ex- 
perience has  shown  the  value  of  occasional  re-immunizations 
against  small-pox,  it  may  be  found  desirable  to  repeat  the 
antityphoid  vaccination  prior  to  special  military  operations 
involving  increased  risk  from  the  disease. 

This  subject  has  received  somewhat  extended  treatment 
because  of  its  great  importance.  The  military  value  of  the 
discovery  of  a  preventive  for  the  scourge  of  armies  is  second 
only  to  that  of  vaccination  against  small-pox. 

Much  that  has  been  said  of  typhoid  fever  applies  equally  to 
dysenteries  and  camp  diarrheas,  which  also  are  due  to  specific 
germs  residing  in  the  intestines  of  infected  individuals. 
These  diseases  occupy  much  space  in  the  medical  history  of 
our  army  in  earlier  times,  though  at  present  they  do  not  often 
appear  in  epidemic  form.  During  our  Civil  War  these  oc- 


72  MILITARY  HYGIENE 

curred  with  much  frequency  and  produced  more  sickness  and 
mortality  than  any  other  form  of  disease. 

Dysentery 

Dysentery  remains  the  most  serious  of  the  diseases  to  which 
our  people  in  the  Philippines  are  liable.  Broadly  speaking, 
dysentery  is  any  inflammatory  disease  of  the  bowels  in  which 
blood  and  mucus  appear  in  the  stools.  Based  upon  their 
causative  factors  there  are  two  types,  the  one  due  to  animal 
(protozoal),  the  other  to  vegetable  (bacterial),  parasites. 

Amebic  Type. — The  principal  form  of  dysentery  under  the 
first  head  is  caused  by  an  ameba,  a  minute  animal  consisting 
of  a  single  cell.  This  is  the  type  which  causes  most  trouble 
in  the  Philippine  Islands;  it  is  also  met  with  in  our  Southern 
States.  The  amebse  enter  the  body  with  food  or  water  and 
produce  inflammations  and  ulcerations  of  the  large  intestine, 
which  are  sometimes  complicated  by  abscesses  of  the  liver. 
Their  natural  home  appears  to  be  the  human  intestine,  and 
from  this  source  they  contaminate  foods  (especially  fruits  and 
green  vegetables)  or  drinking-water. 

Bacillary  Type. — The  bacterial  type  of  dysentery  is  caused 
by  the  bacillus  dysenteries.  Bacillary  dysentery  can  only 
be  told  from  the  amebic  form  by  an  expert,  but  for  our  pur- 
poses this  fact  is  unimportant,  since  our  preventive  measures 
are  the  same  for  both.  This  type  is  very  widely  distributed 
over  temperate  as  well  as  hot  climates,  and  is  the  one  which 
is  responsible  whenever  epidemic  outbreaks  occur  in  an  army. 
The  bacilli  are  conveyed  from  fecal  matter  to  the  mouth  by 
contaminated  food  or  drink.  Flies  are  common  agents  of 


PREVENTABLE  DISEASES.  73 

transference  and  personal  contact  plays  as  large  a  part  as  in 
typhoid.  As  a  result  of  their  presence  in  the  bowel  and  the 
development  of  poisons  (toxins)  resulting  from  their  activities, 
ulcerations  of  the  large  intestine,  hemorrhages  therefrom, 
and  great  prostration  result.  This  form  is  usually  more  act- 
ive and  dangerous  than  the  amebic,  being  sometimes  almost 
as  rapidly  fatal  as  cholera. 

Camp  Diarrheas. — Diarrheas  are  very  common  in  field 
service  and  may  result  from  a  variety  of  causes,  such  as  bad 
food,  poor  cooking,  or  abdominal  chilling.  There  is  also  an 
epidemic  form  (heretofore  referred  to  as  camp  diarrhea) 
which  attacks  large  numbers  of  men  at  one  time  and  is  severe 
in  character.  One  cause  of  epidemic  diarrhea  is  the  dysentery 
bacillus,  which  occasionally  manifests  its  activities  thus,  but 
any  form  of  diarrhea  is  bad,  since  it  not  only  rapidly  weakens  a 
man,  but,  by  irritating  the  intestines,  it  increases  the  liability 
to  attack  by  the  more  serious  affections,  typhoid  fever  and 
dysentery.  Under  conditions  of  active  service  the  importance 
of  "carriers"  of  typhoid,  dysentery,  and  epidemic  diarrheas 
is  greater  than  in  civil  life.  Indeed,  these  probably  consti- 
tute the  most  important  of  all  factors. 

Prevention. — Preventive  measures  for  all  forms  of  dysen- 
teries and  camp  diarrheas  are  identical  with  those  for  typhoid 
fever  save  in  the  matter  of  vaccination,  for  which  we  do  not  as 
yet  possess  an  efficient  agent.  The  water-supply  should  be 
carefully  protected  from  fouling;  the  feces  of  men  sick  with 
these  diseases  should  be  disinfected  or  otherwise  safely  dis- 
posed of;  the  sick  should  be  separated  from  the  well;  and  all 
sources  of  irritation  of  the  intestinal  tract  should  be  avoided. 


74  MILITARY  HYGIENE 

Malaria 

The  malarial  fevers  constitute  an  important  class  of  dis- 
eases. Other  names  by  which  they  are  known  are  ague; 
chills  and  fever;  remittent  fever;  intermittent  fever.  The 
dreaded  Chagres  fever  of  Panama  is  a  form  of  pernicious 
malaria.  There  are  three  types  of  these  fevers,  each  due 
to  a  different  minute  animal  parasite  which  attacks  the 
blood  of  man,  but  it  is  sufficient  for  our  purpose  here  to 
know  that  all  have  a  similar  origin,  namely,  the  bite 
of  an  infected  mosquito.  The  method  of  transmission 
was  discovered  as  recently  as  1898  by  a  British  Army 
surgeon. 

Anopheles  Mosquitoes. — Onfy  one  variety  of  mosquito 
(the  anopheles) — which,  however,  has  rather  numerous 
species — is  capable  of  transmitting  the  germs  responsible  for 
the  disease.  The  mosquitoes  may  be  recognized,  in  their 
adult  or  even  in  their  larval  forms,  by  peculiarities  in  their 
attitudes  when  at  rest.  The  larvae  (popularly  called  "wig- 
glers")  of  harmless  (culex)  mosquitoes  lie  head  downward  in 
the  water  in  which  they  are  developing,  with  only  their 
breathing  tubes  in  contact  with  the  surface.  Those  of  the 
anopheles  lie  parallel  with  the  water's  surface  and  just  be- 
neath it.  Mosquitoes  themselves,  when  resting,  show  oppo- 
site peculiarities;  that  is,  the  common  forms  lie  parallel  with 
the  surface  to  which  they  cling,  while  the  anopheles  rest  with 
their  heads  near  the  surface  and  their  bodies  angling  away 
from  it.  Another  point  of  difference  is  that  the  common 
form  is  humpbacked,  while  the  anopheles  is  nearly  straight 


PREVENTABLE  DISEASES 


75 


Fig.  3. — Larva  of 
culex  mosquito,  resting 
at  the  surface  of  the 
water  (after  Howard). 


from  proboscis  to  tail.  It  is  worthy  of  remark  that  only  fe- 
males are  blood-suckers  and  thus  transmitters  of  malaria. 
The  male  may  readily  be  recognized  by  the  feathery  tuft  on 
his  head. 

Mode  of  Transmission. — The  trans- 
ference of  the  infection  from  one  man 
to  another  is  accomplished  in  the  fol- 
lowing manner:  A  certain  individual 
has  malaria,  which  means  that  he  has 
in  his  blood  the  germs  which  cause  the 
disease.  An  anopheles  mosquito  bites 
him  and  draws  into  her  stomach,  along  with  the  blood,  a 
number  of  these  germs,  which  undergo  a  peculiar  form  of  de- 
_  ^^  .  velopment  within  her  body.  After 

frt         If  this  development  is  complete,  this 

Fig.  4.-Larva  of  anopheles  mosquito  bites  a  healthy  man,  and, 
mosquito  (after  Howard).  injecting  a  little  saliva  through  her 
hollow  proboscis  in  order  to  make  the  blood  more  fluid,  she 
thus  presents  this  second  man  with  a  number  of  undesirable 
guests  in  the  shape  of  malarial  parasites. 
These  promptly  attack  such  of  the  red 
corpuscles  of  his  blood  as  are  most 
available,  and  the  cycle  is  complete. 
Thus,  the  conditions  which  must  exist 
to  favor  the  spread  of  malaria  are :  first, 
an  infected  human  being;  second,  an- 
opheles mosquitoes;  third,  healthy  men; 
and  fourth,  opportunity  afforded  to  the  mosquitoes.  The 
germ  of  the  disease  is  a  microscopic,  single-celled  animal 


Fig.  5. — Larva  of 
stegomyia  mosquito 
(after  Rosenau). 


76 


MILITARY  HYGIENE 


(protozoon).     This  germ  was  discovered  in  1880  by  a  French 

Army  surgeon. 

Prevention. — Preventive  measures  are  as  follows:  first, 

precaution  against  mosquito  bites  by  the  use  of  screens  for 

doors  and  windows,  bars  for  beds, 
and  head-nets  and  gloves  when 
necessary  at  night;  second,  the 
killing  of  mosquitoes  in  houses  by 
fumigation,  trapping,  or  other 
means;  third,  the  destruction  of 
their  breeding-places  (i.  e.,  collec- 
tions of  standing  water),  associated 
with  the  cutting  of  high  grass  and 
underbrush  near  human  habita- 
tions; and  fourth,  the  routine  ad- 
ministration (in  malarious  locali- 
ties) of  small  doses  of  quinin  to 
officers  and  men  and  attached 
civilians.  When  an  individual  is 
known  to  be  infected,  he  should  be 

Fig.  6.-Adult  mosqui-  screened  with  esPecial  Care  tO  Pre' 

toes;  resting  position  on  a  vent  access  of  mosquitoes  to  him. 

wall.    Anopheles  above,  culex  „,            ,    ~                      «    .  -,           .    . 

below  (Howard,  after  Water-  General   GorSaS  1S  °f  the  °Pml0n 

house).  that  when   troops  are  marching 

through  a  malarious  country  the  only  practical  measure  for 
their  protection  is  the  administration  of  quinin.  The  theory 
of  this  procedure  is  that  when  the  malarial  parasites  are  intro- 
duced into  the  blood,  they  find  there  a  substance  hostile 
to  them.  He  says  further,  that  such  anopheles  mosquitoes 


PREVENTABLE  DISEASES  77 

as  may  bite  soldiers  in  campaign,  would  not  likely  be  infected 
unless  the  troops  are  quartered  in  or  camped  near  some 
town.  If  the  camp  is  occupied  for  more  than  a  day  or  two 
the  ground  should,  of  course,  be  cleared  and  accumulations 
of  water  drained  away  or  oiled. 

Tuberculosis 

Tuberculosis  is  what  is  commonly  known  as  "consumption," 
because  of  the  wasting  away  of  the  body  which  is  an  invari- 
able accompaniment.  The  tubercle  bacillus,  which  is  respon- 
sible for  this  disease,  may  and  does  attack  any  part  of  the 
human  body,  but  tuberculosis  of  the  lungs  so  greatly  pre- 
ponderates that  when  we  apply  the  term  the  pulmonary  vari- 
ety is  generally  meant.  Though  this  affection  may  result 
from  food  (especially  milk)  containing  the  tubercle  bacillus, 
the  usual  channel  of  infection  is  by  way  of  the  lungs,  the 
germs  being  carried  in  the  air.  A  soldier  with  the  disease 
may,  before  the  condition  is  suspected,  infect  the  air  of  his 
squad  room  to  such  a  degree  that  all  other  susceptible  indi- 
viduals therein  may  contract  the  disease. 

Coughing  and  Spitting. — The  germs  are  coughed  up  from 
their  seat  in  the  lungs;  the  spitting  habit,  as  we  know,  is  one 
deeply  engrafted  upon  the  American  male;  the  germs  resist 
death  by  drying  to  a  remarkable  degree.  We  are,  therefore, 
likely  to  have  in  barracks  the  conditions  best  suited  to  the 
spread  of  this  disease,  namely,  a  number  of  susceptible  indi- 
viduals closely  aggregated,  an  infected  man  who  scatters 
his  sputum  carelessly  about,  and  close  air,  breathed  over  and 


78  MILITARY  HYGIENE 

over  because  of  the  inadequate  ventilation  so  dear  to  the 
average  crowd. 

Prevention. — The  information  just  given  readily  suggests 
the  means  to  be  employed  to  prevent  the  spread  of  this 
affection,  which  are :  first,  the  exercise  of  great  care  in  recruit- 
ing, to  exclude  those  in  the  early  stages  of  the  disease;  second, 
the  early  recognition  of  such  cases  in  the  military  service, 
with  their  removal  to  a  special  hospital ;  to  this  end,  non-com- 
missioned officers  should  be  required  promptly  to  report  any 
man  who  has  a  persistent  cough;  third,  ample  air  space  per 
man  in  barracks;  fourth,  adequate  ventilation  must  be  pro- 
vided for  and  its  mechanism  carefully  guarded  to  insure 
its  continuous  operation.  In  this  connection  it  is  well  to 
state  that  in  our  service  the  guard-house  is  the  place  most 
commonly  infected,  since  it  is  usually  overcrowded  and  the 
men  of  most  careless  habits  are  apt  to  be  immured  therein. 

Tonsillitis 

Tonsillitis  and  other  throat  affections  are  very  common  in 
barracks  during  cold  weather  and  frequently  occur  in  com- 
pany epidemics.  When  such  is  the  case,  ventilation  is  at 
fault,  and  it  will  usually  be  found  that  the  men,  for  the  sake 
of  warmth,  have  stopped  up  the  air  inlets.  Such  throat 
affections  are  often  quite  severe  and  prostrating  and  may  even 
resemble  diphtheria  at  first.  They  are  not  usually  due  to 
any  one  specific  germ,  but  rather  to  one  or  more  varieties  of 
ordinarily  harmless  bacteria  residing  in  the  throat,  which  have 
taken  on  virulent  properties  by  reason  of  the  lowered  vitality 
of  the  tissues  due  to  bad  air.  The  sick  should  be  isolated 


PREVENTABLE  DISEASES  79 

promptly  and  the  tendency  on  the  part  of  fresh-air  cowards  to 
plug  up  ventilation  shafts  in  cold  weather  must  be  appreciated 
and  combated. 

Influenza 

Influenza,  commonly  known  as  "the  grip,"  occurs  in  epi- 
demic waves  which  affect  the  civilian  population  equally 
with  the  military,  but  as  this  is  clearly  infectious,  being  due 
to  a  well-known  bacillus,  and  is  transmitted  chiefly  if  not 
wholly  by  contact  with  the  sick,  such  contact  should  be 
avoided  as  far  as  possible.  The  influenzal  bacillus  prefers 
to  attack  the  respiratory  system,  but  may  affect  the  digestive 
tract  or  the  membranes  surrounding  the  brain  and  spinal  cord 
instead.  It  is  often  a  serious  disease,  since  such  complications 
as  pneumonia,  meningitis,  and  ear  suppurations  are  not  un- 
usual. Marked  depression  of  spirits  is  a  frequent  accompani- 
ment. Many  people  are  crippled  in  health  for  years  after 

an  attack. 

Colds 

Though  seldom  serious  in  symptoms  or  results,  common 
colds  are  so  frequent  and  temporarily  disabling  that  they 
deserve  mention  here.  Many  of  them  are  undoubtedly 
"catching,"  and  persons  suffering  from  them  should  take 
pains  to  avoid  close  contact  with  others.  A  large  percentage 
of  cases  is  due  to  overcrowding  and  faulty  ventilation  in 
barracks.  Other  causes  are  wet  feet  and  chilling  following 
overheating  of  the  body's  surface. 

Measles 

We  are  apt  to  underrate  the  importance  of  this  highly  con- 
tagious disease,  which,  in  time  of  war,  when  new  levies  of 


SO  MILITARY  HYGIENE 

troops  are  brought  together,  becomes  a  really  serious  condi- 
tion. City-bred  recruits  have  usually  had  an  attack  in  child- 
hood, but  those  from  country  districts  very  like^  have  not 
encountered  the  infection.  The  disease  is  much  more  severe 
in  its  effects  upon  adults  than  upon  children.  In  the  Union 
Army  during  the  Civil  War  there  were  76,000  cases,  with  more 
than  5000  deaths.  Among  the  Confederates  whole  brigades 
were  temporarily  disbanded  on  this  account  in  the  early  part 
of  the  war.  No  means  of  prevention  other  than  isolation  of 
the  sick  and  their  attendants  are  at  present  known.  Measles 
is  due  to  a  virus  whose  exact  nature  is  as  yet  unrecognized. 

Mumps 

Mumps  is  also  a  contagious  disease,  and,  like  measles, 
causes  much  disability  among  newly  raised  troops.  It  is 
not  so  serious  in  its  results  as  measles,  but  is  a  painful  and 
disabling  affection,  especially  when,  as  frequently  happens, 
it  attacks  the  testicles.  Its  ordinary  characteristic  is  an  in- 
flammation of  the  salivary  glands  located  in  the  neck  near 
the  angle  of  the  jaw. 

Cerebrospinal  Fever 

Cerebrospinal  fever  (meningitis)  occurs  with  considerable 
frequency  at  recruiting  depots,  on  transports,  and  in  camps. 
Luckily,  though  many  inhale  the  micrococcm  which  is  its 
cause,  but  few  are  susceptible  to  the  disease.  Direct  con- 
tact is  responsible  for  the  transference  of  the  infection  and 
"carriers"  play  a  large  part  in  its  spread.  It  is  a  very  deadly 
disease  unless  antimeningitic  serum  is  used  promptly. 


PREVENTABLE  DISEASES  81 

Early  recognition  of  its  presence  in  the  command,  rigid  iso- 
lation of  the  sick  and  of  such  carriers  as  can  be  located,  with 
disinfection  of  all  discharges  from  their  throats  and  noses, 
are  the  essentials  in  its  prevention. 

i 
Scarlatina 

Scarlatina  (scarlet  fever),  though  a  highly  contagious  and 
dangerous  disease,  fortunately  attacks  adults  but  seldom,  so 
does  not  need  extended  discussion  in  this  treatise,  but  a  case 
of  sore  throat,  associated  with  a  brilliant  eruption  on  the 
skin,  should  be  regarded  as  suspicious  of  this  disease 
and  immediately  isolated. 

Diphtheria 

Diphtheria,  another  very  contagious  and  serious  affection, 
is  far  less  feared  since  the  discovery  of  its  antitoxin.  This 
substance  has  great  value  in  the  prevention  of  the  disease  as 
well  as  in  its  cure.  It  is  given  hypodermically  to  all  persons 
exposed  to  the  infection,  as  well  as  to  the  sick  man. 

Small-pox 

Small-pox,  the  disease  most  dreaded  by  our  forefathers 
because  of  its  repulsiveness,  its  mortality,  and  its  disfiguring 
effects,  has  been  robbed  of  its  terrors  by  the  wonderful  pro- 
tection afforded  by  vaccination,  but  if  the  antivaccinationists 
had  their  way  this  loathsome  pest  would  reappear,  deadly  as 
ever,  since  it  is  kept  alive  in  many  communities  by  those  who 
evade  the  means  of  prevention. 

Varioloid  is  simply  a  mild  attack  of  small-pox. 


82  MILITARY  HYGIENE 

Hookworm  Disease 

Hookworm  disease  has  recently  been  shown  to  be  of  great 
economic  importance  in  Porto  Rico  and  our  own  South. 
Curiously  enough,  the  animal  source  of  this  affection,  though 
its  home  is  the  human  intestine,  makes  its  way  into  the  body 
of  the  person  attacked  through  the  skin  and  not  by  way  of 
the  mouth.  The  eggs  are  passed  out  with  the  feces  and  the 
larvae— which  constitute  the  infective  form — hatch  outside 
the  body.  The  measures  of  prevention,  therefore,  consist 
of  two  things,  namely,  the  proper  disposal  of  excreta  and  the 

wearing  of  shoes. 

Dengue 

Dengue,  better  known  as  "breakbone  fever/'  is  a  disease 
which  causes  much  sickness  among  our  people  in  the  Philip- 
pines, but  which,  fortunately,  does  not  terminate  fatally. 
In  common  with  malaria  and  yellow  fever,  it  is  transmitted 
by  the  bite  of  a  mosquito,  so  measures  directed  against  this 
pest  receive  an  additional  argument. 

Yellow  Fever 

Thanks  to  the  late  and  deeply  lamented  Major  Walter 
Reed  of  our  Army  Medical  Corps,  who  demonstrated 
the  fact  that  yellow  fever  is  transmitted  by  the  bite  of 
a  certain  mosquito  only,  we  have  succeeded  absolutely  in 
eradicating  this  terrible  disease  from  Cuba  and  Panama, 
where  for  centuries  it  had  been  prevalent.  This  has  been 
accomplished  by  antimosquito  measures  alone.  The  insect 
concerned  in  the  transmission  of  this  disease  is  known  as  the 
stegomyia  calopm  or  "tiger  mosquito,"  the  latter  name 


PREVENTABLE  DISEASES  83 

resulting  from  its  striped  appearance,  by  which  it  may  be 
recognized.  It  is  peculiar  in  the  fact  that  it  bites  chiefly 
in  the  afternoon.  It  is  a  house  mosquito,  residing  in  or  near 
dwellings,  and,  since  it  finds  favorable  breeding  conditions  in 
water-tanks  of  ships,  it  is  often  carried  about  the  world  in 
this  way.  This  fact  gives  rise  to  concern  lest,  when  the 
Panama  Canal  is  opened,  yellow  fever  may  be  carried  from 
points  in  Mexico,  Central  and  South  America,  where  it 
persists,  to  the  Philippines  and  other  parts  of  Asia.  Its 
larva,  like  that  of  the  culex,  floats  head  downward  in  the 
water.  (See  Fig.  5.) 

Cholera 

Cholera,  whose  normal  home  is  the  tropics,  is  by  no  means 
confined  to  warm  climates,  but  is  frequently  brought  to 
our  own  shores.  Since  we  know  its  cause  (the  "comma" 
bacillus)  and  the  fact  that  the  measures  for  its  control  are 
similar  to  those  for  typhoid  fever,  we  do  not  fear  that  it  will 
effect  a  lodgment  in  the  United  States.  Cholera  has  given 
us  much  trouble  in  the  Philippines,  but  even  there,  where 
sanitary  measures  are  carried  out  with  greater  difficulty,  its 
invasions  have  been  met  and  checked. 

Plague 

Plague,  the  "black  death"  of  the  Middle  Ages,  establishes 
itself  independently  of  climate  wherever  it  finds  favorable 
conditions.  It  has  been  demonstrated  that  rats  are  even 
more  liable  to  this  disease  than  man,  and  it  is  well  established 
that  infection  is  usually  incurred  through  the  bite  of  the  rat 
flea,  which,  after  the  death  of  its  normal  host,  forsakes  the 


84  MILITARY  HYGIENE 

latter  and  attacks  man.  Rats  should,  therefore,  he  relent- 
lessly pursued,  their  haunts  made  inaccessible  to  them,  and 
opportunities  for  obtaining  food  cut  off.  Cousins  of  the  rat — 
such  as  the  prairie  dog  of  our  western  plains  and  the  ground 
squirrel  (tarbagan)  of  Manchuria — are  subject  to  the  dis- 
ease and  may  be  agents  in  its  transmission.  In  some  epi- 
demics a  very  deadly  form  ("pneumonic"  plague)  attacks 
the  lungs.  Here  the  germ  is  transmitted  by  breathing  and 
the  flea  is  not  a  factor. 

Beriberi 

Beriberi  is  of  interest  and  importance  for  the  reason  that 
it  has  attacked  many  of  our  Filipino  scouts.  No  perfectly 
authenticated  instance  of  its  occurrence  in  an  American  sol- 
dier is  on  record.  This  does  not  mean  that  they  are  immune, 
but  rather  that  their  food  contains  the  essential  preventive 
substances.  Rice-eating  peoples  are  most  often  affected,  and 
it  has  been  found  that  some  necessary  food  substance  resident 
in  the  husk  of  the  grain  has  been  removed  in  the  polishing 
process  to  which  the  higher  grades  of  rice  has  been  subjected. 
By  substituting  an  "undermilled"  rice  for  the  polished  vari- 
eties, this  disease  has  been  entirely  controlled  among  the 
scouts,  and  its  incidence  much  lessened  among  the  Filipinos 
generally.  This  is  the  latest  instance  of  the  beneficent  effects, 
upon  the  health  of  the  native  populations,  of  the  occupation 
of  tropical  lands  by  the  American  Army. 

Scurvy 

Scurvy  is  a  disease  resulting  from  scant  or  improper  diet 
and  was  formerly  common  among  armies  and  navies.  It  is 


PREVENTABLE  DISEASES  85 

now  but  seldom  encountered,  although  beleagured  garrisons 
(as  the  Russians  in  Port  Arthur)  and  remote  detachments  (as 
in  Alaska)  are  sometimes  affected.  Its  chief  causative  factor 
is  the  absence  from  the  diet  of  organic  acids  contained  in 
fresh  meats  and  vegetables.  Potatoes,  onions,  tomatoes  (raw 
or  canned),  vinegar,  the  juices  of  rare  meats,  lemon  and  lime 
juice  are  preventive  and  curative. 

Leprosy 

Leprosy  is  mentioned  because  of  the  popular  interest  in 
this  affection  and  not  because  of  the  risks  of  contact.  Its 
germ  is  feebly  contagious  and  no  apprehension  need  be  felt 
if  its  victims  are  encountered. 

Effects  of  Heat 

The  effects  of  heat  are  frequently  noted  on  the  march  in 
hot  weather.  These  effects  are  of  two  kinds,  notably  differ- 
ing in  symptoms.  In  the  severer  type  (heatstroke)  the  sick 
man  is  unconscious,  his  face  is  scarlet,  his  pulses  throb  vio- 
lently, and  his  skin  feels  burning  hot.  In  the  other  condition 
(heat  exhaustion)  the  consciousness  is  retained,  but  the  man 
feels  exhausted,  his  face  is  pale,  his  heart  beats  feebly,  and  his 
skin  is  cold  and  clammy.  Heatstroke  is  most  apt  to  occur 
when  the  air  is  not  only  very  warm,  but  is  surcharged  with 
moisture  as  well.  Evaporation  from  the  skin  is  interfered 
with,  and  as  such  evaporation  is  an  important  means  whereby 
excess  heat  is  withdrawn  from  the  body,  the  temperature  may 
rise  to  a  dangerous  degree.  These  heat  effects  can  largely 
be  avoided  by  timing  the  march,  when  possible,  to  take  place 


86  MILITARY  HYGIENE 

during  the  relatively  cooler  parts  of  the  day.  The  head  cover- 
ing should  have  a  roomy  air  space  and  the  crown  should  con- 
tain some  light,  moist  object,  as  a  wet  sponge  or  handkerchief 
or  green  leaves.  Water  should  be  sparingly  drunk  on  the 
march;  the  man  who  empties  his  canteen  between  halts  is 
most  often  the  man  who  is  overcome  by  heat. 

Alcoholic  Excess 

Alcoholic  excess  is  a  potent  source  of  disability,  not  only 
in  its  immediate  effects,  but  by  opening  the  way  to  the  onset 
of  many  other  disease  conditions  through  the  lessening  of 
vitality.  This  subject  will  be  discussed  more  at  length 
in  a  later  chapter. 

Skin  Eruptions 

Skin  eruptions  are  very  common  in  campaign,  for  the 
reason  that  men  cannot  or  do  not  keep  their  persons  and 
clothing  in  a  sufficiently  cleanly  state.  The  affections  which 
occur  most  often  are  those  due  to  the  presence  of  small 
animal  parasites.  Of  these,  lice  are  the  most  objectionable. 
The  hirsute  parts  of  the  head  and  body  should  be  inspected 
for  the  eggs  of  these  insects,  which  are  readily  seen  as  little 
masses  attached  to  the  individual  hairs.  When  insects  or 
their  eggs  are  found,  the  man's  underclothing  should  be  boiled 
and  the  affected  parts  of  his  body  shaved  or  freely  anointed 
with  mercurial  ointment. 

Biting  Insects,  Etc. 

Itch  mites  and  chiggers  (red  bugs)  cause  much  discom- 
fort by  burrowing  beneath  the  skin.  Ticks  and  leeches 


PREVENTABLE  DISEASES  87 

fasten  themselves  upon  the  body.  Fleas,  mosquitoes,  and 
biting  flies  abound  in  certain  localities.  Some  of  these 
insects — as  lice,  ticks,  fleas,  and  mosquitoes — are  known 
to  be  concerned  in  the  transmission  of  serious  diseases. 
In  regions  where  they  are  common,  men  should  be  taught  to 
recognize  them,  with  a  view  to  their  avoidance  and  the 
prompt  relief  of  injuries  induced  by  them.  An  acute  inflam- 
mation of  the  skin  results  from  contact  with  the  leaves  of  the 
so-called  poison-oak  or  ivy  in  susceptible  people.  Men  should 
learn  to  know  these  plants  too. 

Blistered  Feet 

Large  numbers  of  men  are  incapacitated — particularly 
at  the  onset  of  a  campaign — by  blistered  feet.  The 
two  chief  causes  of  blisters  on  the  feet  of  the  march- 
ing soldier  are  bad  fitting  shoes  and  uncleanliness.  The 
feet  should  be  kept  dry  if  possible;  shoes,  when  wet, 
wrinkle  and  lose  their  shape.  To  insure  keeping  the  feet 
in  good  condition,  their  daily  washing,  after  getting  into 
camp,  is  absolutely  necessary.  If  sufficient  water  is  not 
at  hand,  wipe  the  feet  carefully — especially  between  the  toes 
—with  a  wet  rag. 

Shoes. — The  shoe  is,  at  least  for  the  infantryman,  the 
most  important  article  of  clothing.  It  is  only  after  many 
years  of  experiment  that  a  rational  marching  shoe  has  been 
developed  for  our  service,  and  the  urgent  necessity  for 
exactness  in  the  fitting  of  each  soldier  with  these  articles 
and  for  their  proper  care,  appreciated.  Company  com- 
manders are  now  held  responsible  for  undue  injuries  to  the 


88  MILITARY  HYGIENE 

feet  of  their  men  from  ill-fitting  footwear.  Each  man  should 
have  at  least  one  pair,  well  broken  in,  for  marching  use. 
Men  should  be  instructed  in  the  care  of  shoes  and  of  feet, 
and  frequent  inspections  of  both  should  be  made. 

Socks. — An  infantry  soldier  should  carry  two  or  three 
pairs  of  socks,  which  ought  to  be  soft,  smooth,  and  undarned. 
Those  worn  on  the  day's  march  should  be  washed  at  the 
same  time  as  the  feet;  clean,  dry  socks  are  then  put  on  and 
the  wet  ones  hung  up  to  dry.  In  this  way  a  clean  pair 
may  always  be  had.  A  woolen  sock  (light  or  heavy)  is  more 
comfortable  when  marching  than  a  cotton  one  because  it  is 
softer  and  more  yielding,  while  it  absorbs  the  perspiration 
better.  If  perspiration  of  feet  is  excessive,  a  thin  cotton 
sock  under  one  of  light  wool  does  well. 

Prevention  of  Blisters. — To  prevent  blisters,  foot  baths 
of  strong  brine  or  alum  or  alcohol,  used  for  a  week  or  more 
before  the  march,  are  of  great  service  in  hardening  the 
skin.  Many  experienced  soldiers  of  our  army  soap  the 
feet  before  putting  on  their  socks.  In  the  German  Army, 
socks  (or  rags,  which  many  wear  for  economy's  sake)  are 
soaked  in  grease.  An  excellent  powder,  made  up  of  starch, 
soapstone,  and  salicylic  acid,  is  supplied  by  our  medical 
department  to  sift  into  the  socks.  These  measures  are 
used  to  diminish  the  friction  of  the  foot  against  the  sock. 
The  French  have  found  that  a  small  strap  buckled  about  the 
instep,  over  the  shoe,  diminishes  friction  and  lessens  the 
tendency  to  the  formation  of  blisters.  (See  Fig.  9.)  If 
such  form  in  spite  of  our  care,  they  must  be  opened  to 
allow  the  serum  to  escape. 


PREVENTABLE  DISEASES  89 

Treatment. — The  opening  is  made  at  the  lowest  point  of 
the  blister,  with  a  clean  needle,  after  the  feet  have  been 
washed.  The  raised  skin  must  not  be  disturbed,  but  is  to 
be  dressed  with  vaselin  or  other  ointment  and  protected 
from  pressure  by  adhesive  plaster.  Men  afflicted  with  bun- 
ions or  corns  should  be  required  to  report  promptly  to  the 
surgeon  for  appropriate  treatment. 


CHAPTER  VI 
CLOTHING 

Purposes. — Clothing  protects  the  body  against  the 
changing  conditions  of  the  weather,  such  as  cold,  heat, 
wind,  and  rain;  shields  in  a  measure  from  blows  and  bruises; 
and  serves  to  adorn  the  person.  The  materials  used  for  this 
purpose  are  derived  from  a  variety  of  sources,  animal  and 
vegetable.  The  chief  substances  taken  from  the  animal 
world  are  wool,  fur,  leather,  and  silk;  from  the  vegetable 
kingdom  we  obtain  cotton,  linen,  and  rubber,  as  well  as  a 
number  of  less  important  materials.  A  good  material  for 
clothing  purposes  must  meet  the  following  requirements: 

1.  It  must  afford  proper  protection  against  the  weather. 

2.  It  must  not  interfere  with  the  natural  functions  of 
the  skin. 

3.  It  must  exert  no  irritating  effect  upon  the  skin. 

The  characteristics  and  merits  of  the  more  important 
substances  will  be  considered  briefly. 

Wool  is  undoubtedly  the  most  valuable  of  these  substances 
used  by  us.  It  has  the  merits  (a)  of  being  a  poor  heat  con- 
ductor, thus  retarding  escape  of  warmth  from  the  body  and 
preventing  the  thermic  rays  of  the  sun  from  passing  freely. 
Through  its  heat  conservation  it  is  much  warmer  than  cot- 
ton, and  when  loosely  woven,  so  that  much  air  is  entangled 
in  the  meshes  of  the  fabric,  its  warmth  is  markedly  in- 

90 


CLOTHING  91 

creased.  This  property  makes  it  most  valuable  in  cold 
climates,  and  even  in  hot  ones  it  is  not  altogether  undesir- 
able. The  olive  drab  flannel  overshirt  has  been  found  to  be 
a  very  valuable  garment  in  tropical  field  service.  By  day 
it  keeps  out  heat  and  chemical  rays,  and  by  night  it  prevents 
chilling,  (b)  Wool  is  a  great  absorber  of  water,  a  very 
important  quality,  as  evaporation  from  the  body's  surface 
during  free  perspiration  is  checked  and  the  danger  of  chill 
lessened.  Perspiration  passes  through  linen  and  cotton 
freely  and  loss  of  heat  is  rapid,  (c)  It  does  not  absorb  odors 
readily.  A  disadvantage  of  wool  is  that  its  fibers  become 
smaller  and  harder  after  washing,  so  that  garments  of  which 
it  is  composed  undergo  marked  shrinking  and  stiffening. 
This  tendency  is  minimized  by  washing  as  follows:  Plunge 
garments,  one  at  a  time,  in  hot  soapsuds  and  use  gentle 
friction  to  cleanse  from  dirt.  Remove  and  rinse  out  all 
soap  carefully  with  cold  water.  Hang  up  to  dry  without 
wringing.  Stretch  into  shape  while  drying  if  a  tendency 
to  shrink  is  observed. 

Cotton  is  next  to  wool  in  value  for  purposes  of  clothing. 
It  has  these  merits:  (a)  Good  wearing  qualities;  (b)  cheap- 
ness; (c)  non-shrinkage  in  washing;  (d)  coolness.  Its  de- 
merits are:  (a)  Rapid  heat  conductivity;  (b)  poor  water 
absorption;  (c)  free  absorption  and  release  of  odors. 

Merino  (a  mixture  of  cotton  and  wool)  is  much  used 
for  underwear. 

Linen  (flax  fiber)  conducts  heat  even  more  rapidly  than 
cotton  and  is  also  a  poor  absorbent  of  moisture,  besides 
being  much  more  expensive  than  cotton. 


92  MILITARY  HYGIENE 

Paper. — It  is  useful  to  know  that  paper  is  of  value  in 
conserving  warmth,  and  the  Japanese  have  utilized  it  in 
military  clothing.  A  paper  vest  affords  marked  protection 
against  cold  winds,  while  a  newspaper  between  blankets 
adds  much  to  comfort  on  a  cold  night. 

Warmth  and  Coolness. — The  warmth  or  coolness  of  cloth- 
ing depends  upon  several  factors:  these  are  material,  text- 
ure, and  color.  We  have  seen  that,  according  to  heat  con- 
ductivity, the  materials  named,  in  order  of  warmth,  are  wool, 
cotton,  linen.  Conversely,  linen  is  coolest.  With  respect 
to  texture,  the  more  loosely  woven  the  material,  the  warmer 
the  garment.  Thus,  a  cotton  or  linen  loose  mesh  undershirt 
is  much  superior  to  one  that  is  closely  woven.  The  same 
effect  of  warmth  may  be  produced  by  wearing  two  or  more 
thin  undergarments,  one  over  the  other,  the  advantage 
resulting  not  so  much  from  the  increased  thickness  as  from 
the  layers  of  warmed  air.  Color  is  of  importance  in  this 
connection,  in  accordance  with  its  relative  heat-absorbing 
properties.  Thus,  white  absorbs  least  heat;  black,  the  most. 
Black  clothes  are,  therefore,  warmest;  white,  coolest;  blue 
is  next  to  black  for  warmth:  olive  drab  and  khaki  are  cooler 
than  blue.  Olive  drab,  being  darker,  is  markedly  warmer 
than  khaki. 

Waterproofing. — Clothing  may  be  waterproofed  in  several 
ways.  The  best  known  of  these  is  a  coating  of  rubber. 
Rubber-coated  materials  are  impermeable  to  moisture  from 
within  as  well  as  without.  Thus,  perspiration  is  fostered 
and  evaporation  minimized,  with  much  resultant  discom- 
fort. This  objection  applies,  with  somewhat  less  force, 


CLOTHING  93 

to  raincoats  and  slickers  made  waterproof  by  a  varnishing 
or  oiling  process.  But  woolen  and  other  materials  may  be 
waterproofed  without  losing  their  porosity  by  impregnating 
them  (a)  with  aluminum  acetate  or  (6)  with  a  solution,  in 
benzine,  of  sheep's  wool  fat  (lanolin).  These  processes 
may  be  readily  carried  out  in  the  field,  if  found  to  be  neces- 
sary or  desirable. 

Military  Attire. — There  are  certain  requirements  in  cloth- 
ing designed  for  the  military  service  which  are  not  neces- 
sary for  civilian  attire.  The  outer  dress  should  be  such  as 
to  maintain  the  soldier's  pride  in  his  calling  and  to  indicate 
his  place  in  the  service,  while  the  color  of  that  designed 
for  field  use  must,  in  its  relation  to  visibility  at  a  distance 
and  against  varying  backgrounds,  be  inconspicuous.  Most 
of  the  great  military  nations  have  adopted  a  special  color 
looking  to  this  end,  the  British  being  the  leaders,  with  their 
"khaki"  (A  Hindoo  word  meaning  "brown").  The  Ger- 
mans, Italians,  Spanish,  French,  and  Russians  have  chosen 
gray  shades,  some  with  a  greenish  admixture.  Much  ex- 
periment indicates  that  our  so-called  "olive  drab"  approxi- 
mates the  ideal  shade  for  this  purpose  more  nearly  even  than 
gray.  The  olive  drab  has  but  little  advantage  over  khaki 
in  this  particular. 

Having  in  mind  the  principles  discussed,  the  chief  points 
to  be  considered  in  the  selection  of  clothing  for  the  mili- 
tary service  are:  (1)  Good  quality;  (2)  durability;  (3)  mod- 
erate cost;  (4)  permeability  to  air;  (5)  heat  conduction  and 
absorption;  (6)  color,  with  respect  to  warmth  and  visi- 
bility; (7)  distinctiveness. 


94  MILITARY  HYGIENE 

In  our  service  all  necessary  articles  are  supplied  by  the 
government:  these  are  usually  of  good  quality,  reason- 
ably well  made,  and  satisfactorily  adapted  to  the  uses  for 
which  they  are  designed.  Unfortunately,  we  have  been 
for  years  and  still  are  in  a  transition  period,  during  which 
changes  of  outer  clothing  have  been  frequent.  The  result 
has  been  that  a  company  frequently  appears  in  motley  rather 
than  in  uniform.  The  total  weight  of  the  clothing  proper 
varies  from  6J  to  11J  pounds,  in  accordance  with  climate 
and  season. 

Headgear. — Until  very  recent  years,  most  inappropriate 
headgear  was  worn  in  field  service.  Cortez,  in  Mexico,  and 
Magellan,  in  the  Philippines,  wore  brass  helmets.  The 
huge  shako  of  the  British  Grenadier  in  the  Crimea  and  the 
absurdly  inadequate  cap  of  the  Federal  soldier  in  our  Civil 
War  are  fairly  modern  examples,  at  opposite  ends  of  the 
scale  of  size.  Some  nations  still  send  their  troops  to  war 
in  head  coverings  illy  adapted  for  protection.  Of  these,  the 
German  helmet  ("pickelhaube"),  the  French  cap  ("kepi"), 
and  the  Turkish  "fez"  are  conspicuous  types. 

The  headdress  is  intended  to  afford  protection  from 
cold  and  heat  and  to  shield  the  eyes  and  the  back  of  the  neck 
from  solar  rays.  The  style  of  garrison  hat  or  cap  is  rela- 
tively unimportant.  That  for  field  service  should  be  light 
in  weight  and  color,  broad  brimmed,  well  ventilated,  and 
not  easily  dislodged!  Our  service  hat  is  perhaps  best  adapted 
of  all  military  headgear  in  current  use,  but  is  by  no  means 
perfect.  The  "Montana  peak"  which  has  recently  sup- 
planted the  crease  in  the  crown  is  a  step  in  the  right  direc- 


CLOTHING  95 

tion,  as  it  improves  the  ventilation.  To  better  the  circu- 
lation of  air  still  more,  a  fluted  strip  should  be  inserted 
between  the  hat  and  its  sweatband.  The  brim  is  now  stiff, 
but  the  question  as  to  whether  this  stiffening  should  be 
removed  is  still  under  discussion.  The  stiff  brim  is  under- 
stood to  have  been  adopted  in  deference  to  the  view  that  a 
military  garment,  even  in  the  field,  should  be  neat.  But 
dear  to  the  hearts  of  those  who  wore  it.  in  active  service  is 
its  soft-brimmed  predecessor,  the  "campaign"  hat. 

For  tropical  wear  a  khaki-covered  cork  or  pith  helmet  is 
undoubtedly  cooler  than  the  service  hat.  On  the  other 
hand,  it  is  very  bulky  and  sets  so  insecurely  upon  the  head 
as  to  cause  much  annoyance  by  frequent  dislodgment. 
For  cold  weather  two  types  of  cap  are  issued,  the  one  of 
muskrat  fur,  the  other  of  canvas.  Both  are  blanket  lined 
and  have  turn-down  flaps  for  covering  the  ears.  The  fur 
cap  is  much  the  better  in  warmth  and  appearance. 

Military  Coats. — There  is  a  great  variety  of  taste  in  mili- 
tary coats  worn  by  modern  armies.  Those  for  garrison 
use  are  still  designed  more  for  display  than  for  comfort. 
Here  the  dictum  that  the  circulation,  respiration,  and 
free  muscular  movements  should  not  be  interfered  with  is 
quite  cast  aside  and  the  nearest  approximation  to  "a  perfect 
fit"  possible  is  often  sought.  Comfort  is  entirely  secondary 
to  appearance.  Still,  we  must  no  doubt  sacrifice  something 
to  the  principle  that  the  soldier's  pride  in  his  calling  should 
be  fostered,  and  it  is  well  known  that  a  handsome  uniform 
is  a  good  stimulus  to  recruiting.  For  campaign  wear  the 
loose-fitting  olive  drab  blouse  with  large  patch  pockets  is 


96  MILITARY  HYGIENE 

an  excellent  garment.  In  hot  weather  this  coat  is  discarded 
and  the  olive  drab  flannel  shirt  is  worn  as  the  outer  gar- 
ment; this  is  an  admirable  concession  to  comfort  and  good 
sense.  In  cold  weather  the  blouse  will  usually  be  replaced 
by  a  heavy  wool  sweater. 

Overcoat. — Two  kinds  of  overcoats  are  used  in  our  ser- 
vice. That  ordinarily  issued  and  worn  is  of  drab  woolen 
cloth,  thinly  lined.  It  was  formerly  equipped  with  a  hood, 
which,  for  reasons  not  understood,  is.  no  longer  authorized. 
In  weather  of  moderate  severity  this  is  a  fairly  satisfactory 
garment.  By  recent  regulation  it  does  not  become  the 
property  of  the  soldier,  but  its  continued  ownership  is  vested 
in  the  United  States.  The  frequent  issue  of  a  long  overcoat 
to  a  short  man  and  the  reverse  is  a  common  observation. 
The  front  corners  of  the  skirts  are  provided  with  buttons 
and  flap,  that  they  may  be  turned  back  in  marching.  But 
even  with  this  provision,  marching  of  foot  troops  is  decidedly 
hampered  by  the  overcoat.  This  garment  is  much  too  thin 
to  afford  protection  against  extreme  cold.  For  such  weather 
an  overcoat  made  of  brown  canvas  and  lined  with  blanket 
is  an  occasional  issue.  This  is  a  superior  article  and  affords 
excellent  protection  against  cold  winds,  as  well  as  rain. 

Mackinaw  Coat. — For  Alaskan  service  a  short  Mackinaw 
coat  of  heavy  blue  woolen  material  is  furnished,  since  the 
overcoat  would  too  much  impede  free  movements  in  deep 
snow.  And  with  the  view  that  it  may,  after  due  trial,  super- 
sede the  overcoat  and  render  this  garment  unnecessary  for 
field  service,  a  heavy  sweater,  knitted  of  wool  and  cotton 
and  olive  drab  in  color,  is  now  supplied.  The  merits  of 


CLOTHING  97 

such  a  garment  are  obvious,  but  whether  it  will  sufficiently 
conserve  the  heat  of  the  body  in  extreme  cold  remains  to  be 
proved.  At  any  rate,  it  is  possible  to  wear  the  overcoat  with 
the  sweater. 

The  poncho  is  an  outer  garment  designed  to  protect  the 
wearer  from  rain.  This  is  a  sort  of  waterproof  blanket, 
whose  distinctive  feature  is  a  slit  through  which  the  heacj 
passes.  The  idea  is  borrowed  from  our  Latin-American 
neighbors.  A  light  varnished  cotton,  olive  drab  in  color,  now 
replaces  the  heavy  rubber  poncho  for  the  use  of  foot  troops 
in  our  army.  Attempts  have  been  made  to  perfect  a  gar- 
ment of  this  type  which  shall  perform  an  additional  function 
as  a  shelter  tent  half.  Such  double  use  has  an  advantage 
and  a  disadvantage.  In  the  first  place,  the  weight  of  the 
soldier's  pack  would  be  reduced  by  about  2J  pounds.  On 
the  other  hand,  one  of  the  most  important  uses  of  the  poncho 
is  as  a  ground  cloth  at  night,  to  keep  the  body  and  clothing 
from  direct  contact  with  wet  soil.  With  the  poncho  form- 
ing part  of  a  tent,  this  use  must  be  abandoned  unless,  on 
occasions  when  such  protection  is  especially  necessary, 
three  men  shall  occupy  the  shelter,  the  poncho  of  the  third 
forming  the  floor.  The  new  style  poncho  may  be  folded 
and  buttoned  to  form  a  sleeping  bag. 

The  slicker,  a  long  and  voluminous  outer  coat  of  oiled 
cotton  cloth,  is  worn  by  mounted  troops  in  place  of  the 
poncho. 

For  garrison  wear,  trousers  are  supplied  as  part  of  the 
dress,  the  white  and  the  fatigue  uniforms.  Suspenders  or  a 
belt  may  be  worn  for  their  support,  according  to  individual 


98  MILITARY  HYGIENE 

preference.  With  the  service  uniform,  breeches  are  worn 
with  leggings.  For  field  wear,  breeches  are  far  more  satis- 
factory than  trousers,  as  the  latter  are  bulky  at  their  lower 
ends,  which,  too,  may  become  heavy  with  mud  or  water. 
Breeches  are  apt  to  compress  the  legs  behind  the  knees, 
especially  in  the  seated  or  squatting  attitudes.  The  service 
uniform  is  now  required  for  daily  wear  in  garrison,  and,  as 
thus  used,  the  breeches  become  open  to  certain  objection. 
While  undoubtedly  neater  and  more  distinctive  than  trousers, 
their  constant  use  in  garrison,  particularly  by  those  whose 
duties  are  sedentary,  is  undesirable.  The  close  fit  of  the 
breeches  and  leggings,  at  and  below  the  knees,  may  produce 
a  degree  of  constriction  which  markedly  interferes  with  the 
circulation  of  the  legs  and  feet,  thus  favoring  muscular 
cramps  and  varicose  veins.  Breeches  should  fit  snugly 
about  the  waist  and  upper  part  of  the  pelvis,  but  from  the 
hips  to  a  point  below  the  knees  they  should  be  quite  loose, 
even  baggy.  They  should  have  ample  pockets  at  sides  and 
back  and  should  be  laced  (not  buttoned)  at  their  lower  ends. 

Service  Uniform. — The  service  uniform  is  provided  in 
two  materials,  wool  and  cotton,  both  olive  drab  in  color. 
The  former  is  designed  for  cold,  the  latter  for  warm,  weather. 
The  olive  drab  cotton  goods  thus  far  supplied  are  distinctly 
inferior  to  the  khaki  previously  issued  in  several  particulars. 
The  color  fades  and  "runs"  in  washing,  the  uniform  is  not 
so  neat  in  appearance,  and  the  darker  shade  is  notably 
warmer. 

Leggings  are  worn  with  breeches,  since  the  latter  end 
above  the  ankles,  leaving  a  space  otherwise  unprotected 


CLOTHING  99 

except  by  the  stocking.  They  protect  the  legs  from  bruis- 
ing, shield  the  breeches,  socks,  and  shoe  uppers  from  mud  and 
burrs,  and  afford  support  to  the  leg  muscles.  Many  types 
have  been  tried  out  in  our  service  and  found  wanting.  The 
new  issue,  of  stout  canvas,  without  a  foot  strap  and  secured 
(at  three  points  only)  by  a  cord,  promises  well.  Its  main 
defect  is  that,  being  laced  and  reinforced  in  front,  it  may 
exert  uncomfortable  pressure  upon  the  shin  bone.  Leggings 
of  leather,  fastened  by  a  strap,  are  worn  by  mounted  men. 
Another  form  of  legging,  much  used  in  the  British  Army 
and  authorized  for  officers'  field  wear  in  our  service,  is  the 
"puttee,"  a  long  woolen  bandage  which  is  applied  spirally 
about  the  leg.  The  fit  and  resultant  pressure  on  the  leg 
are  more  uniform  than  with  other  leggings,  and  the  appear- 
ance is  neat,  but  the  adjustment  takes  considerable  time. 
This  question  of  time  required  to  clothe  one's  self  when  on 
campaign  is  a  serious  one.  The  lacing  of  breeches  and  leg- 
gings is  slow  work.  It  would  seem  that  a  heavy  woolen 
sock  leg,  drawn  up  over  the  breeches,  would  fulfil  all  the 
purposes  of  a  legging  (except  neatness),  save  much  time  in 
dressing,  and  be  more  comfortable.  This  style  of  dress  is 
much  worn  by  guides  and  hunters  in  our  northern  woods. 
Gloves  are  at  present  authorized  and  issued  in  great 
variety,  in  the  endeavor  to  suit  these  articles  to  all  climates, 
seasons,  and  conditions  of  service.  Many  of  these  are 
intended  for  parade  and  social  uses.  Mention  may  be  made 
of  mittens  for  very  cold  stations;  of  woolen  gloves  in  olive 
drab  for  ordinary  wear;  of  leather  ones  to  protect  the  hands 
of  those  handling  heavy  guns  and  machinery;  and  of  gaunt- 


100  MILITARY  HYGIENE 

lets  (gloves  with  a  large,  flaring  cuff)  for  mounted  service. 
A  useful  provision  to  prevent  loss  in  winter  field  service  is  to 
fasten  the  gloves  together  by  a  long  cord  which  passes  through 
the  coat  sleeves  and  across  the  shoulders. 

Underwear. — From  the  standpoint  of  ordinary  hygiene, 
the  most  important  part  of  the  clothing  is  the  underwear, 
since  it  comes  in  direct  contact  with  the  person,  and  must, 
therefore,  be  frequently  changed  and  cleansed.  The  under- 
clothing should  vary  in  weight  and  material  with  season  and 
climate.  Wool  of  varying  thickness  suits  many,  winter 
and  summer,  and,  when  well  borne  by  the  skin,  is  the  best 
material.  But  wool  often  produces  cutaneous  irritation, 
and  individuals  thus  affected  naturally  prefer  other  materials. 
Efficient  cold-resisting  substitutes  are:  (a)  Merino;  (6)  a 
woolen  or  merino  garment  over  a  thin  cotton  one;  (c)  two 
garments  of  cotton.  Underclothing  should  be  light  in 
color,  for  the  reason  that  dark  shades  absorb  odors  (as  of 
perspiration)  more  readily. 

Undershirts  are  now  regularly  issued  to  our  troops  in 
three  weights — light  cotton,  light  and  heavy  merino.  A 
fleece-lined  shirt  is  also  provided  for  posts  where  cold  is 
extreme.  Those  who  are  subject  to  sharp  diarrheal  attacks 
not  explainable  by  dietetic  errors  will  do  well  to  wear  a 
small,  apron-shaped  additional  covering  for  the  protection 
of  the  abdominal  organs,  especially  at  night. 

The  olive  drab  overshirt  has  already  been  mentioned  as 
a  garment  of  exceptional  merit.  It  has  a  turn-down  collar 
and  breast  pockets,  which  give  it  a  neat  appearance  when 
it  is  worn  without  the  blouse  or  sweater. 


CLOTHI'NG  101 

Drawers  are  provided  in  weights  and  materials  similar 
to  those  of  the  undershirts.  They  should  be  roomy,  for 
greater  warmth  and  freedom  of  movement.  The  band 
should  not  be  tight,  as  constriction  by  a  narrow  girdle  may 
displace  the  internal  organs.  Drawers  should  reach  to  the 
ankles  and  be  fitted  snugly  there  by  an  elastic  webbing. 
Strings  in  that  situation  are  objectionable  by  reason  of  breakr 
age  and  pressure  of  the  knots,  while  buttons  cause  pressure 
and  are  easily  lost.  The  knee-length  drawers  which  have 
lately  become  fashionable  do  not  afford  adequate  protec- 
tion against  dust  and  contact  with  dirty  outer  clothing. 

Socks  are  furnished  in  cotton  and  in  light  and  heavy 
wool.  Those  of  cotton  are  suitable  for  garrison  wear,  but 
not  for  marching.  Those  of  light  wool  (which  are  really  50 
per  cent,  cotton)  are  used  by  the  majority  of  our  men  on 
field  service.  The  heavy  socks,  of  pure  wool,  are  quite 
bulky,  but  are  superior  for  marching  wear,  except  in  the 
rare  cases  in  which  they  cause  skin  irritation.  Wool  ab- 
sorbs perspiration  better,  stretches  better,  and  fits  more 
uniformly,  so  it  is  less  likely  to  form  creases  and  produce 
blisters,  calluses,  and  corns.  Socks  should  have  a  seamless 
foot,  with  reinforced  toes  and  heels.  They  should  fit  well 
and  have  no  rough  thread  ends.  It  is  of  interest  to  note 
that  only  two  armies  other  than  our  own  issue  socks  to 
their  soldiers.  These  are  Great  Britain  and  Japan.  The 
great  military  nations  of  the  European  Continent  expect 
their  men  to  provide  themselves  somehow  with  these  articles, 
which  by  us  are  deemed  of  such  importance.  From  motives 
of  economy  many  German  soldiers  wrap  oil-soaked  cloths 


102  MILITARY  liYGIENE 

about  their  feet  in  lieu  of  socks.  A  British  military  sani- 
tarian (Colonel  Melville)  estimates  the  life  of  a  sock  to  be 
only  60  to  70  road  miles.  This  is  probably  a  fair  mileage 
for  our  light  wool  sock,  but  it  is  believed  that  the  heavy 
woolen  article  will  do  considerably  better.  Comfort  and 
cleanliness  as  well  as  regulations  require  that  socks  shall 
be  changed  and  washed  daily  on  the  march.  It  is  well  to 
remember  that  a  piece  of  soft  cloth  a  foot  square  (wool  or 
part  wool)  will  make  a  better  foot  covering  than  a  worn  out 
or  poorly  darned  sock. 

Garters  are  useful,  but  care  should  be  taken  to  avoid 
undue  constriction,  which  interferes  with  the  normal  circu- 
lation of  parts  below. 

Shoes. — No  one  article  of  the  soldier's  clothing  plays  so 
large  a  part  in  his  efficiency  as  the  shoe.  Although  army 
commanders  and  sanitarians  of  the  past  century  have  empha- 
sized the  importance  of  good  footwear,  it  is  but  very  recently 
that  the  military  shoe  has  received  scientific  study.  The 
marching  ability  of  armies  is  second  to  no  other  military 
factor,  yet,  while  enormous  percentages  of  troops  in  cam- 
paign have  been  incapacitated  by  injuries  to  the  feet  due  to 
shoes  badly  made,  shaped  or  fitted,  it  has  but  lately  been 
realized  that  the  conditions  were  preventable.  A  board  of 
officers  convened  for  the  purpose  by  our  War  Department 
has  recently  (1912)  rendered  its  report  in  the  form  of  a 
truly  admirable  study  of  the  foot  and  the  shoe.  A  number 
of  important  recommendations  are  made  in  this  report, 
among  which  are:  (a)  The  adoption  of  shoes  made  on  a 
rational  last  (one  developed  by  the  board) ;  (b)  careful  fitting 


CLOTHING  103 

by  company  officers  personally;  (c)  full  series  of  sizes  carried 
in  stock  at  posts;  (d)  frequent  inspections  of  feet  by  com- 
pany and  medical  officers.  The  War  Department  has  adop- 
ted these  recommendations  and  has  published  them  in  the 
form  of  an  order,  in  which  occurs  the  following  sentence: 
"Hereafter  an  undue  amount  of  injury  and  disability  from 
shoes  will  be  regarded  as  evidence  of  inefficiency  on  the 
part  of  the  officers  concerned  and  as  cause  for  investigation." 
This  places  the  responsibility  where  it  belongs,  and  officers 
will  do  well  to  study  most  carefully  the  foot  and  its  cover- 
ings. This  may  best  be  done  by  consulting  the  work  "The 
Soldier's  Foot  and  the  Military  Shoe,"  by  Major  Munson, 
Medical  Corps,  United  States  Army,  president  of  the  army 
shoe  board  above  referred  to.  Major  Munson  lays  down  the 
following  requirements  for  a  good  military  shoe: 

(a)  It  must  be  of  good  materials  and  well  made. 

(6)   It  must  be  fairly  flexible,  with  pliable  and  porous  uppers. 

(c)  The  interior  should  be  perfectly  smooth,  the  heel  broad 
and  low,  the  sole  but  moderately  thick. 

(d)  The  arch  should  be  flexible  and  without  metal  shank 
or  other  stiffening. 

(e)  It  should  have  eyelets  (not  hooks)  for  fastening,  and 
the  tongue  should  lie  smooth  under  the  laces. 

(/)  The  shoe  should  reach  only  a  little  above  the  ankle; 
it  should  be  wide  across  the  ball  of  the  foot  and  should  have 
a  high  toe  cap. 

(g)  It  must  be  comfortable,  neat  looking,  and  light  in 
weight. 

(h)  It  must  be  easily  put  on  and  removed. 


104 


MILITARY  HYGIENE 


Civilian  Models. — The  styles  of  shoes  purchasable  in 
the  shops  are  practically  all  defective  in  shape  and  unsuit- 
able for  marching.  The  "toothpick"  type  and  even  broad- 
toed  models  produce  a  forced  outward  angling  at  the  junc- 


Fig.  7. — Skiagrams  (x-ray  pictures)  of  feet:  Left,  well-shaped  foot 
in  new  model  army  shoe.  Right,  deformed  foot  in  type  of  shoe 
responsible  for  the  deformity. 

tion  of  the  great  toe  with  the  main  portion  of  the  foot. 
This  shifts  the  axis  of  the  foot,  which  normally  should  be 
directly  to  the  front  in  marching.  Shoes  as  ordinarily 
purchased  are  too  small  for  the  wearer,  either  in  length, 
in  breadth,  or  in  both  these  dimensions.  It  must  be  re- 


CLOTHING  105 

membered  that  the  soldier  is  obliged  to  carry  a  load  of 
clothing  and  equipment  amounting  to  at  least  40  pounds. 
Under  such  a  weight  the  foot,  if  unconfined,  lengthens  and 
broadens  to  a  surprising  degree.  This  may  amount  to  more 
than  J  inch  from  heel  to  toe  and  nearly  as  much  across  the 
ball.  The  lengthening  is  more  pronounced  in  a  high-arched 
foot.  It  is  thus  evident  that,  to  avoid  injury  in  marching, 
the  shoe  must  be  roomy  enough  to  allow  all  or  a  major  part 
of  this  normal  expansion. 

Supervision  in  Fitting. — Soldiers  cannot  be  trusted  to  fit 
themselves  with  marching  shoes,  as,  through  ignorance 
or  vanity  (or,  perhaps,  lack  of  proper  sizes),  tight-fitting 
footwear  will  usually  be  chosen  or  accepted.  Thus  the 
supervision  of  officers  becomes  necessary. 

How  to  Fit  Shoes. — Feet  are  measured  and  shoes  fitted 
by  company  commanders  in  the  following  manner:  The 
soldier  stands  with  bared  foot  upon  a  small,  graduated  meas- 
uring board,  resting  his  entire  weight  (augmented  by  a  40- 
pound  burden  on  his  back)  upon  that  foot.  The  length  of 
the  expanded  foot  is  read  off  from  the  board  and  the  circum- 
ference around  the  ball  is  taken  by  means  of  a  tape  applied 
at  the  base  of  the  toes  (Fig.  8).  An  approximation  to  the 
correct  shoe  length  is  then  determined  by  adding  2  to  the 
scale  reading.  For  width,  the  table  of  sizes  given  in  the 
annual  price  list  of  clothing,  issued  by  the  Quartermaster 
General,  should  be  consulted.  For  example,  let  us  assume 
that  a  foot  measures  6J  on  the  scale  and  has  a  circumfer- 
ence of  9J  at  the  ball.  Size  8J  D  is  found  to  be  the  shoe 
which  should  approximate  a  fit;  if  this  is  not  quite  correct, 


106 


MILITARY  HYGIENE 


others  will  be  tried  on  until  a  satisfactory  fit  is  had.  With 
each  trial  the  shoe  should  be  snugly  laced  and  the  soldier 
will  throw  his  augmented  weight  upon  the  shod  foot.  The 
company  commander  personally  verifies  the  fit,  assuring 
himself  especially,  by  pressure  with  his  hand,  that  not  less 
than  f  inch  of  vacant  space  exists  in  front  of  the  great 
toe  and  that  no  undue  pressure  or  wrinkling  exists  over  the 
ball  of  the  foot. 


Fig.  8. — Foot  measuring  diagram  (Munson). 

Breaking  in. — New  shoes  should  be  adapted  to  the 
contours  of  the  feet  by  gradual  wear  and  should  on  no  oc- 
casion be  used  for  marching  until  broken  in.  If  there  is 
need  for  haste  in  the  process,  this  may  be  accomplished  by 
having  the  soldier  stand  in  water  for  a  few  minutes  until 
the  leather  is  sodden.  He  should  then  walk  about  for  an 
hour  or  so  on  a  level  surface,  letting  the  shoes  dry  on  his 
feet.  On  removal,  a  little  neat's-foot  oil  should  be  rubbed 
into  the  leather  to  prevent  hardening  and  cracking.  Shoes 


CLOTHING 


107 


may  Jbe  ivaterproofed  by  rubbing  a  considerable  amount  of 
this  oil  into  the  dry  leather. 

It  is  believed  that  with  the  adoption  of  the  new  shoe  and 
its  complete  supply  to  the  army,  to  the  exclusion  of  other 
styles,  our  service  will  have  footwear  much  superior  to  that 
of  any  other  nation.  The 
average  American  has  a  foot 
rendered  abnormal  by  long 
wear  of  shoes  of  bad  shape  or 
improper  size.  But,  taken  in 
conjunction  with  the  oversight 
in  fitting  and  care  of  the  feet 
now  rendered  obligatory,  we 
should  have  a  minimum  of 
foot  troubles.  The  high  boots 
worn  by  German  and  Russian 
foot  troops  furnish  a  striking 
contrast  to  our  own  shoes  in 
appearance,  comfort,  and  effi- 
ciency. That  men  can  march 
at  all  in  such  clumsy,  mis- 
shapen footwear  as  that  of  the 
foreign  nations  cited  is  sur- 
prising. The  weight  of  such  boots  is  4  pounds,  which  is 
twice  that  of  our  shoes.  (See  Fig.  11.) 

Overshoes  are  desirable  for  garrison  wear,  but  not  usually 
practicable  in  field  service.  The  "arctic"  type  is  the  only 
one  officially  supplied. 


Fig.  9. — New    army   shoe,  leg- 
ging, and  marching  strap. 


CHAPTER  VII 
EQUIPMENT 

Definition. — The  equipment  of  a  soldier  (or  equipage,  as 
it  is  sometimes  termed)  includes  all  articles,  other  than  his 
clothing,  which  are  essential  to  the  performance  of  his 
duties.  To  some  extent  clothing  and  equipage  overlap, 
since  such  articles  as  overcoats,  ponchos,  slickers,  and 
sweaters,  already  described  under  the  former  head,  are 
sometimes  listed  as  the  latter.  It  is  obvious  that  a  fighting 
man  must  carry  the  tools  of  his  trade,  with  certain  other 
articles  necessary  to  his  comfort  and  health.  But  it  is 
equally  obvious  that  such  articles  have  decided  limita- 
tions with  respect  to  weight,  bulk,  shape,  and  number. 
A  man  of  average  size  and  strength  can  carry  but  a 
limited  burden  with  the  expectation  that,  at  the  end  of 
a  march,  he  will  be  fit  for  his  prime  function,  that  of 
battle.  It  has  been  found  that,  for  our  service  at  least, 
the  weight  carried  by  the  infantry  soldier  should  not  ex- 
ceed 50  pounds. 

The  actual  weight  of  the  full  equipment  is  40  pounds,  6 
ounces,  which,  with  the  service  clothing  (7  pounds,  13 
ounces),  makes  a  total  burden  of  48  pounds,  3  ounces.  This 
is  made  up  as  follows: 

108 


EQUIPMENT  109 

Table  of  Articles  of  Equipage,  with  Weight  of  Each 

Pounds.         Ounces. 

Clothing  (one  extra  pair  of  socks) 7  13 

Rifle  and  sling 9  .92 

Cartridges  (100  rounds) 5  15.88 

Cartridge  belt. 1  6.10 

Intrenching  tool  and  carrier  (shovel) 2  2.04 

Bayonet  and  scabbard 1  5.48 

First  aid  packet  and  pouch 5.59 

Canteen  (filled)  with  cup  and  cover 3  10.03 

Haversack 1  9.85 

Pack  carrier 7.32 

Blanket 3  1 

Shelter  tent  half,  with  5  pins 11.68 

Poncho 3 

Meat  can,  knife,  fork,  and  spoon 1  1.21 

Rations    (2  reserve)   with  containers  (1   bacon  can, 

1  condiment  can) 4  1 .72 

Toilet  articles  (towel,  soap,  tooth  brush,  comb) 7 

Total  (full  equipment) ~48  2.82 

Table  of  Weights  Carried  by  Foot  Soldiers  (Canteen  Filled) 

Pounds. 

American  (new  equipment) 48 

American  (old  equipment) 56 

British 52 

Japanese 55 

French 56 

Italian 58 

German .  . 60 

Russian 60 

Austrian 63 

Note. — The  weights  given  are  approximate  and  may  vary  some- 
what in  either  direction,  according  to  whether  special  articles  (as  over- 
coats and  intrenching  tools)  are  carried  or  others  (as  shelter  tents  and 
ponchos)  are  discarded  temporarily. 

The  burden  borne  by  our  soldiers  is  considerably  less 
than  that  carried  by  the  men  of  foreign  armies.  Other 
things  being  equal,  this  fact  should  make  our  men  more 
efficient.  But  certain  races  are  accustomed  to  burden  bear- 


110 


MILITARY  HYGIENE 


ing.  The  Japanese  coolie  is  capable  of  carrying  a  load 
amounting  to  more  than  half  his  own  weight,  while  the 
American  soldier  cannot  be  expected  to  do  better  than  one- 
third. 


Fig.  10. — Infantrymen  of  foreign  armies,  with  field  equipment. 
Left,  British;  neat  pack  and  good  arrangement  of  components.  Right, 
French;  note  the  inadequate  cap  and  the  top-heavy  pack  (after  Lavisse). 

Articles  Making  Up  the  Load. — The  articles  composing 
the  load  (or  pack,  as  it  is  often  termed)  fall  under  several 
heads  with  respect  to  their  nature.  These  are:  (a)  Clothing; 
(6)  armament  (including  rifle,  bayonet,  ammunition,  and 


EQUIPMENT 


111 


intrenching  tool) ;  (c)  food  (rations,  water,  mess  equipment) ; 
(d)  accoutrements  (haversack,  pack  carrier,  belt,  first  aid 
packet,  identification  tag);  (e)  shelter  (overcoat,  poncho, 
blanket,  shelter  tent);  (/).  personal  necessaries  (toilet  requi- 
sites, tobacco,  etc.). 


Fig.  11. — Infantrymen  of  foreign  armies,  with  field  equipment. 
Left,  German;  note  headgear  and  footwear.  Right,  Russian;  note 
blanket  roll  and  boots  (after  Lavisse). 

Forms  of  Packs. — The  arrangement  of  the  several  com- 
ponents of  the  load  upon  the  person  of  the  soldier  varies 
as  greatly  among  armies  as  does  the  style  of  pack.  France, 
Germany,  Austria,  and  Italy  employ  some  form  of  knapsack, 


112  MILITARY  HYGIENE 

in  and  about  which  the  equipments  are  placed.  Russia 
makes  use  of  a  blanket  roll,  a  form  of  pack  recently  dis- 
carded by  us.  Japan  has  a  knapsack,  which  is  replaced  by 
a  roll  over  each  shoulder  when  action  impends.  England 
and  the  United  States  use  a  combined  haversack  and  pack 
carrier.  In  shape,  appearance,  material,  internal  arrange- 
ment, and  contents,  no  two  of  these  devices  are  alike,  thus 
clearly  indicating  that  the  pack  even  approximating  the  ideal 
is  still  to  be  found. 

The  Ideal  Pack. — In  its  report,  the  Infantry  Equipment 
Board  which  devised  the  outfit  recently  adopted  by  the 
United  States  Army  well  describes  the  needs  in  this  particu- 
lar as  follows:  "The  ideal  load  would  be  one  as  light  as 
possible  consistent  with  containing  all  of  the  articles  essen- 
tial to  the  soldier's  purpose,  health,  and  comfort;  one  whose 
distribution  upon  the  framework  of  the  body  is  such  that 
its  center  of  gravity  coincides  with  that  of  the  bearer  and 
whose  weight  is  transmitted  to  the  medium  of  locomotion, 
the  legs,  with  the  minimum  effort  and  fatigue  to  the  medium 
of  transmission,  the  body;  and  one  which  may  be  borne 
without  interference  with  the  vital  organs  and  limbs." 

United  States  Army  Pack  (New  Model). — Our  own  con- 
trivance, recently  adopted,  but  not  yet  (1914)  fully  issued  to 
the  army,  is  a  radical  departure  from  former  types,  and  is 
believed  to  be  a  marked  improvement  over  all  others  in  the 
matters  of  lightness,  method  of  carriage,  arrangement  of 
parts,  and  convenience  of  access.  The  whole  is  supported 
by  broad  braces  passing  round  each  shoulder  from  front  to 
rear  and  is  steadied  below  by  straps  attached  to  the  belt. 


EQUIPMENT 


113 


The  equipage  is  divided  into  two  portions  in  such  manner 
that  the  non-essentials  (chiefly  shelter  articles)  may  be  rapidly 


Fig.  12. — United  States  infantrymen,  with  old  and  new  packs  contrasted. 

detached  for  carriage  by  wheeled  transportation  or  before 
going  into  battle.  Thus  the  soldier,  when  transportation  is 
available,  carries  the  so-called  "normal"  equipment,  com- 


114  MILITARY  HYGIENE 

prising  the  clothing  actually  worn,  his  armament,  and  his 
food  (with  the  necessary  mess  kit),  from  any  of  which  it  is 
not  possible  to  separate  him  without  sacrificing  his  quality 
of  self-support.  It  is  thus  evident  that  there  is  an  irreducible 
minimum,  which  with  us  amounts  to  about  31 J  pounds  on 
the  march  (normal  equipment}  and  39  pounds  in  combat 
(fighting  equipment}  The  increase  of  the  latter  over  the 
former  is  due  to  the  addition  of  two  bandoleers  (120  rounds) 
of  cartridges,  the  rest  of  the  equipment  remaining  identical. 
The  new  equipments  effect  a  saving  in  weight  of  more  than 
8  pounds. 

The  Carriage  of  the  Load. — The  position  of  a  load  upon 
the  back  is  very  important.  If  high,  it  tends  to  raise  the 
center  of  gravity,  to  require  greater  effort  in  maintaining  the 
erect  posture,,  and  to  constrict  the  blood-vessels  and  nerves 
of  the  armpits.  The  main  load  should,  therefore,  be  carried 
well  down  the  back.  Also,  it  should  not  lie  in  close  contact 
with  the  body,  but  should  tend  to  fall  away  therefrom,  that 
interference  with  perspiration  in  this  situation  be  minimized. 
The  United  States  Army  equipment  lies  with  its  greater 
diameter  along  the  spine,  in  the  normal  line  of  gravity,  and, 
the  points  of  origin  and  insertion  of  its  supporting  braces 
being  far  apart,  it  produces  but  little  pressure  upon  the  back 
or  constriction  of  the  axillary  contents.  The  play  of  the 
chest  is  only  slightly  interfered  with,  as  no  straps  cross  it. 

Transportation  for  packs  should  be  provided  whenever 
possible,  in  order  to  conserve  the  soldier's  strength.  When 
so  carried  a  grave  disadvantage  may  result  on  active  service, 
in  that  the  equipment  may  not  be  available  when  needed. 


EQUIPMENT  115 

This  objection  applies  also  to  removal  of  part  of  the  equip- 
ment before  going  into  battle,  as  packs  may  never  be  seen 
again,  whether  on  advance  or  retreat.  There  are  many 
historic  instances  of  such  loss.  Raw  troops  especially  would 
sufi'er  from  the  lack  of  shelter  and  of  little  comforts. 

The  Blanket  Roll. — It  is  not  altogether  improbable  that 
our  infantry  in  war  time  will  discard  the  new  pack  and , 
again  resort  to  the  blanket  roll,  as  they  did  in  the  Civil  War. 
The  disadvantages  of  the  latter  are  recognized  and  led  to 
its  replacement  in  our  service,  but  it  has  advantages  to  the 
heavily  laden  soldier.  Its  principal  disadvantage  lies  in 
the  pressure  it  exerts  upon  the  chest,  thus  interfering  with 
breathing. 

Articles  of  Equipage 

Haversack  and  Pack  Carrier. — The  container — known  as 
the  haversack  and  pack  carrier — consists  of  an  irregularly 
triangular  piece  of  stout  canvas,  provided  with  flaps,  straps, 
and  buckles,  the  whole  being  designed  to  fold  about  and 
enclose  the  smaller  items  of  equipment.  There  is  but  one 
pocket  and  the  entire  device  may  be  spread  out  flat  for  ready 
cleansing.  The  haversack  pocket  holds  the  meat  can,  in- 
side of  which  the  knife,  fork,  and  spoon  are  carried.  The 
components  of  the  haversack  ration,  in  their  special  con- 
tainers, are  laid  upon  the  middle  of  the  canvas,  together  with 
the  toilet  articles,  and  there  secured  by  flaps  and  straps. 
If  carried,  the  shelter  articles  (tent,  blanket,  and  poncho) 
are  tightly  rolled  and  fastened  below  the  haversack  con- 
tents by  means  of  that  part  of  the  device  known  as  the 
"pack  carrier,"  which  forms  the  apex  of  the  canvas  triangle. 


116  MILITARY  HYGIENE 

The  carrier,  with  its  roll,  is  known  as  the  "pack";  this  is 
readily  detached  from  the  haversack  by  the  withdrawal  of 
a  coupling  strap. 

The  blanket  is  an  excellent  article  of  wool,  and  now  weighs 
but  3  pounds  instead  of  5J,  as  previously  issued.  This  blan- 
ket is  warm  enough  for  most  seasons;  if  two  must  be  carried, 
they  are  much  warmer  than  the  heavy  single  one  because 
of  the  non-conducting  layer  of  warmed  air  between  them. 


Fig.  13. — United  States  Army  shelter  tent,  new  model. 

The  shelter  tent  protects  two  men,  each  of  whom  carries 
a  half.  These  halves  may  be  buttoned  together  and  set  up 
in  a  few  minutes.  A  rifle  supports  the  higher  (front)  end, 
a  bayonet  or  intrenching  tool  the  rear.  The  tent  is  of  light, 
waterproofed  cotton  material  resembling  that  from  which 
the  poncho  is  made. 

The  cartridge  belt  is  of  stout  cotton  webbing,  has  pockets 
for  cartridges  in  front,  and  is  adjusted  for  size  at  the  back. 


EQUIPMENT  117 

A  valuable  feature  of  this  belt  is  that  its  weight  is  supported 
from  the  shoulders  by  means  of  three  straps  attached  to  the 
haversack.  This  takes  the  pressure  off  the  lower  part  of  the 
abdomen  and  disposes  of  the  objection  that  a  heavy  belt 
tends  to  produce  hernia  or  contusion  of  internal  organs. 
Moreover,  the  weight  of  the  belt  and  cartridges  in  front  acts 
as  a  partial  counterbalance  for  the  knapsack  and  its  load.  ! 

The  bandoleer  is  a  broad  cartridge  belt,  worn  over  the 
shoulder  and  across  the  body.  This  is  a  convenient  method 
of  carrying  ammunition,  but  is  decidedly  objectionable  for 
the  reason  that  its  great  weight  upon  the  chest  interferes 
seriously  with  the  respiration,  as  well  as  with  evaporation 
of  perspiration  from  the  area  which  it  covers.  In  our  service 
it  is  used  only  for  the  carriage  of  additional  ammunition  in 
battle,  and  soldiers  are  instructed  to  use  cartridges  there- 
from before  depleting  the  supply  in  the  cartridge  belt  proper. 

The  rifle  is  the  heaviest  of  all  the  equipments.  Since 
this  essential  component  of  the  load  must  usually  be  carried 
in  the  hand  or  upon  the  shoulder,  and  constitutes  a  weight 
which  is  shifted  from  time  to  time,  it  tends  to  make  the  whole 
load  asymmetric.  It  is,  therefore,  found  to  make  a  demand 
upon  the  energies  of  the  soldier  which  is  much  greater  than 
that  of  a  fixed  weight.  With  the  new  equipments  the 
bayonet,  in  its  scabbard  of  webbing,  is  attached  to  the  pack. 

Intrenching  tools  are  of  two  kinds:  one  is  a  shovel,  the 
other  a  combined  pick  and  mattock.  Less  than  half  the 
men  carry  these,  and  they  may  be  shifted  to  other  men  on 
alternate  days  of  a  march.  They  are  carried  on  the  lower 
part  of  the  pack,  from  which  they  may  be  detached- readily. 


118  MILITARY  HYGIENE 

Canteen  and  Cup. — The  canteen,  whose  capacity  is  one 
quart,  is  of  seamless  aluminum  and  has  a  wide  mouth  closed 
by  a  screw  cap.  The  kidney-shaped  pint  cup,  also  of  alu- 
minum, has  a  folding  handle  and  fits  over  the  lower  part 
of  the  canteen.  Both  these  vessels  may  be  utilized  as  cook- 
ing utensils  in  the  preparation  of  food  or  the  boiling  of  sus- 
picious waters. 

The  first  aid  packet,  since  its  adoption  by  armies,  has  con- 
tributed greatly  (in  fact,  more  than  any  one  cause  or  sum  of 
causes)  to  the  saving  of  lives  of  those  wounded  in  battle. 
Surgery  has  made  wonderful  advances  in  the  last  genera- 
tion, but  a  great  merit  of  the  first  aid  packet  lies  in  making 
operative  surgery  superfluous  in  a  large  number  of  cases. 
The  infection  of  wounds  by  the  bacteria  which  find  therein 
the  conditions  best  suited  for  their  activities  is  usually 
prevented  by  the  prompt  application  of  the  contents  of  the 
packet.  The  bandages  and  compresses  of  cheese-cloth 
(absorbent  cotton  gauze)  are  treated  with  bichlorid  of  mer- 
cury, a  powerful  germicide.  A  tight  metal  case  protects  the 
packet  from  contamination.  This  is  easily  opened  and  the 
contents  readily  applied,  in  accordance  with  simple  direc- 
tions enclosed  with  the  packet.  Soldiers  in  war  quickly 
learn  to  value  and  to  preserve  their  packets.  In  our  ser- 
vice it  is  carried  in  a  small  pouch  of  webbing  which  is  attached 
to  the  belt  and  is  quite  accessible.  It  is  variously  carried 
in  foreign  armies,  sometimes  in  the  coat  pocket  or  sewed 
in  the  coat  lining.  As  the  coat  is  likely  to  be  discarded  in 
the  heat  of  action,  the  packet  may  be  missing  when  most 
needed. 


EQUIPMENT 


119 


Surplus  Kit  Bag. — Certain  additional  articles  required 
by  the  soldier  in  campaign  are  carried  in  a  canvas  sack 
known  as  the  surplus  kit  bag.  One  of  these  is  assigned 
to  each  squad  of  8  men,  and  its  contents  comprise  the 


Fig.  14. — United  States  cavalryman,  mounted;  normal  equipment,  new 
model  (Cavalry  Equipment  Board). 

sweater  (if  not  worn),  with  a  change  of  shoes  and  under- 
clothing for  each  man. 

Cavalry  Equipments. — In  the  mounted  branches  of  the 
service  the  weight  of  the  equipments  is  borne  by  the  horse. 
It  is  as  important  to  the  cavalry  not  to  overload  their  mounts, 


120 


MILITARY  HYGIENE 


as  it  is  to  the  infantry  to  avoid  undue  weighting  of  the  in- 
dividual soldier.     A  cavalry  equipment  board  has  recently 


Fig.  15. — United  States  cavalryman,  dismounted  to  fight  on  foot;  new 
model  equipment  (Cavalry  Equipment  Board). 

(1913)  succeeded  in  reducing  the  weight  of  equipage  by  17 
pounds.     As  the  actual  weight  carried  by  the  horse  was  not 


EQUIPMENT  121 

believed  to  be  excessive,  the  board  found  it  possible  by  this 
reduction  to  add  extra  ammunition,  extra  rations,  and 
grain  to  the  load.  Assuming  a  weight  of  150  pounds  for  the 
trooper,  the  average  animal  must  sustain  a  burden  of  at 
least  245  pounds  (Fig.  14).  This  may  be  increased  to  282 
pounds  by  the  necessity  for  additional  clothing,  ammuni- 
tion, or  special  equipment,  or  it  may  be  reduced  materially 
if  wagon  transport  is  available.  The  articles  of  the  new 
equipment  are  now  in  process  of  manufacture  and,  it  is  an- 
ticipated, will  soon  be  issued.  Our  cavalry  is  trained  to 
fight  on  foot  as  well  as  on  horseback,  and  the  new  equipment 
is  devised  with  the  idea  that,  though  separated  from  his 
mount,  the  man  is  still  self-supporting  and  in  condition  to 
perform  his  battle  functions.  The  accompanying  illustra- 
tion (Fig.  15)  shows  the  dismounted  trooper,  equipped  with 
his  armament,  food,  and  mess  kit. 


CHAFPER    VIII 
WATER-SUPPLY 

Necessity. — Water  is  absolutely  essential  to  the  exist- 
ence of  all  forms  of  life,  whether  animal  or  vegetable.  Man 
can  exist  without  food  for  many  days,  but  can  bear  depriva- 
tion of  water  for  a  very  much  shorter  time.  Means  for 
its  supply  in  adequate  quantities  and  sufficient  purity  must 
be  arranged  for  by  all  communities,  civil  or  military,  per- 
manent or  temporary.  Water  constitutes  over  60  per  cent, 
of  the  weight  of  human  tissues,  and,  as  it  is  constantly  being 
given  off  from  the  body  through  the  lungs,  skin,  kidneys, 
and  intestines,  it  must  as  constantly  be  replaced.  It  forms 
a  part,  also,  of  all  substances  used  as  food,  solid  as  well  as 
liquid.  Bread,  for  example,  contains  33  per  cent,  of  water, 
and  green  vegetables  as  much  as  90  per  cent. 

Functions. — It  is  obvious,  from  the  fact  of  its  constant 
presence  in  such  quantities,  that  water  must  serve  import- 
ant functions  in  the  human  economy.  These  functions  are : 
(a)  To  give  fluidity  to  the  liquids  of  the  body;  (6)  to  soften 
and  render  pliable  the  various  tissues  in  which  these  quali- 
ties are  necessary;  (c)  to  take  part  in  the  chemical  and 
physical  changes  peculiar  to  normal  bodily  processes;  (d) 
it  plays  a  large  part  in  the  regulation 'of  the  temperature. 

Man  makes  use  of  water  for  ordinary  domestic  purposes 

as   follows:    (1)   drinking;   (2)   cooking;   (3)   cleansing;    (4) 
122 


WATER-SUPPLY  123 

removal  of  wastes  (sewerage).  A  relatively  small  amount 
is  required  for  drinking  purposes,  but  a  large  reserve  must 
always  be  available  for  cleansing,  flushing,  and  emergency 
use,  as  well  as  to  provide  against  times  of  drought  and  con- 
flagration. Where  the  supply  of  drinking-water  is  scanty,  it 
is  sometimes  necessary  to  install  a  double  system  (as  of 
sea  and  distilled  water  on  shipboard).  A  system  of  supply 
implies  a  supplementary  system  for  the  disposal  of  waste 
water. 

Quantity. — In  field  service  each  man  requires  daily  at  least 
2J  quarts  for  drinking  and  cooking,  and  as  much  more  for 
washing  his  person  and  clothing.  In  the  tropics  this  amount 
must  be  increased  by  at  least  one-third.  In  camps  of  some 
permanency  he  should  have  not  less  than  5  gallons.  In 
garrison,  a  much  larger  quantity  is  desirable  and,  indeed, 
necessary.  Including  that  required  for  sewerage  and  add- 
ing the  practically  inevitable  wastage,  a  minimum  of  30 
gallons  per  head  should  be  provided.  A  horse  will  drink 
about  8  gallons  per  day.  In  estimating  needs,  10  per  cent, 
should  be  added  for  fire  purposes. 

Sources. — Water  is  ordinarily  derived  from  natural  de- 
posits on  or  near  the  earth's  surface,  as  streams,  lakes, 
springs,  and  wells,  and  the  supply  is  maintained  by  the  rain- 
fall. Rainwater  itself  is  sometimes  collected  from  house 
roofs  and  stored  in  cisterns  for  domestic  use.  The  British 
fortress  of  Gibraltar  derives  its  entire  supply  from  this 
source.  It  is  especially  useful  for  washing  and  cooking  on 
account  of  its  softness,  that  is,  its  freedom  from  mineral 
salts  (chiefly  calcium  and  magnesium)  in  solution.  Cisterns 


124  MILITARY  HYGIENE 

must  be  carefully  screened  in  order  that  they  may  not  serve 
as  breeding-places  for  mosquitoes. 

Hardness  is  of  two  kinds,  temporary  and  permanent. 
The  former  results  from  the  presence  of  chalk  (calcium  car- 
bonate) held  in  solution  by  carbon  dioxid  also  present  in 
the  water.  When  the  gas  is  driven  off  by  boiling,  the  chalk 
is  precipitated.  If  water  contains  more  than  10  grains  of 
mineral  salts  to  the  gallon,  it  is  classed  as  hard.  Extreme 
examples  of  this  type  are  found  in  the  alkali  waters  of  our 
western  states.  Hardness  of  water  has  certain  disadvan- 
tages. It  deposits  a  chalky  material  upon  boilers  and  pipes; 
it  hinders  the  cooking  of  meats  and  vegetables  (notably  that 
army  staple,  beans);  and  it  causes  great  waste  of  soap  in 
washing. 

Impurities. — With  respect  to  the  source  of  drinking-water, 
that  derived  from  springs  or  deep  wells  is  most  apt  to  be 
wholesome.  Next  to  these  is  upland  surface  water  (moun- 
tain streams  and  lakes).  Shallow  wells  and  streams  sub- 
ject to  contamination  are  dangerous  sources,  and  water 
derived  therefrom  generally  requires  purification  before  it 
is  fit  to  drink.  The  physical  characteristics  of  good  drink- 
ing-water are:  appearance,  clear,  colorless,  brilliant;  odor, 
none,  even  after  warming  and  shaking  in  a  closed  vessel; 
taste,  palatable.  But  the  presence  of  all  these  by  no  means 
insures  purity,  and  a  water  exhibiting  such  characteristics 
may  be  dangerously  contaminated,  even  with  sewage.  Im- 
purities prejudicial  to  health  may  be  derived  from  mineral, 
vegetable,  or  animal  sources,  of  which  the  last  named  is  by 
far  the  most  serious.  Under  the  'first  head  may  be  cited: 


WATER-SUPPLY  125 

(a)  Lead,  derived  by  solution  from  pipes  of  that  metal; 
(6)  copper,  iron,  and  other  metals  washed  into  streams  as 
wastes  from  manufactories;  (c)  insoluble  earthy  particles 
in  a  finely  divided  state,  held  in  suspension.  Minute  vege- 
table growths  (algae)  not  infrequently  impart  an  unpleasant 
fishy  taste  and  odor  to  stored  waters,  and  decaying  vegeta- 
tion may  add  products  of  organic  decomposition.  Bacteria 
are  microscopic  vegetable  organisms,  but  since  the  disease- 
producing  varieties  are  parasites  upon  man  and  invariably 
derived  from  him,  they  are  properly  considered  under  the 
third  head.  Such  bacteria  constitute  the  chief  danger  in 
drinking-water  and  the  principal  diseases  to  which  they  may 
give  rise  are  typhoid  fever,  cholera,  and  bacillary  dysentery. 
Still  other  diseases,  due  to  minute  animal  parasites,  are  trans- 
mitted in  exactly  the  same  way,  that  is,  as  the  result  of  con- 
tamination with  discharges  from  the  bowels  of  infected  human 
beings.  Amebic  dysentery  is  the  most  important  member  of 
this  group.  It  should  be  remembered  that  while  the  fouling 
of  the  water-supply  is  not  the  only  method  of  transmission 
of  these  diseases,  such  method  is  extremely  common  and  is 
apt  to  affect  large  numbers  of  individuals  at  one  time. 

Pollution  of  Water-supply. — As  already  suggested,  the 
contamination  of  the  water-supply  by  sewage  (the  term  here 
particularly  referring  to  human  excretions)  is  the  most  serious 
kind  of  pollution.  Opportunities  for  such  fouling  are  con- 
stantly being  afforded.  Men  are  prone  to  void  their  excre- 
ment on  the  margins  of  streams  or  even  directly  into  the 
water.  The  insanitary  methods  of  disposal  of  such  material 
from  railway  trains  is  a  constant  menace  to  the  purity  of 


126  MILITARY  HYGIENE 

bodies  of  water  along  the  right  of  way.  Privies  and  wells 
exist  in  close  proximity  in  our  rural  districts.  Furthermore, 
the  sewage  of  inland  towns  and  cities  usually  discharges  into 
streams.  It  must  not  be  inferred,  however,  that  because 
sewage  has  entered  a  water-supply,  such  supply  is  certain  to 
induce  disease,  for  this  is  not  necessarily  the  case.  It  may 
not  contain  the  germs  of  the  diseases  thus  conveyed.  Never- 
theless, it  is  not  pleasant  to  contemplate  the  drinking  of 
diluted  sewage,  and  the  risk  that  water  so  tainted  is  infected 
is  very  great.  It  is  highly  important,  therefore,  to  obtain  a 
supply  as  pure  as  possible  and  to  protect  it  from  pollution. 
The  outflow  from  sewerage  systems,  house  wastes,  refuse 
from  factories,  garbage,  dead  animals,  and  other  foul  mate- 
rials must  not  be  placed  in  or  near  streams,  lakes,  and  reser- 
voirs which  form  part  of  the  system  of  supply.  Horses  and 
cattle  must  be  kept  out  of  water  sources.  Privies  and  stables 
must  not  be  allowed  upon  their  banks.  Bathing  and  wash- 
ing of  clothing  in  their  waters  must  be  prohibited.  Picnic 
parties,  if  permitted,  must  be  supervised.  Finally,  an  effect- 
ive system  of  inspection  of  the  entire  drainage  area  must  be 
instituted. 

Determination  of  Sewage  Pollution. — The  determination 
of  the  presence  of  sewage  in  a  suspected  water  is  not  easy. 
The  findings  of  a  chemical  examination  merely  indicate 
probabilities,  which  must  be  confirmed  by  a  study  of  the 
local  conditions  and,  more  particularly,  by  a  bacteriologic 
examination.  The  index  of  pollution  in  this  latter  case  is 
the  presence  of  the  colon  bacillus,  so  called  from  the  fact 
that  its  normal  home  is  the  large  intestine.  Even  when 


WATER-SUPPLY  127 

found,  this  bacillus  does  not  necessarily  indicate  contami- 
nation with  human  excrement,  for  it  may  be  derived  from 
cattle.  But,  for  practical  purposes,  its  presence  absolutely 
negatives  the  use  of  such  water  for  drinking  unless  first 
purified. 

Purification. — We  come  now  to  the  consideration  of  prac- 
tical matters  which  especially  concern  us  as  military  sani- 
tarians, that  is,  to  methods  of  purification  of  unsafe  waters. 
The  questions  as  to  the  exact  quality  and  composition  of 
waters  must  be  left  to  the  experts  of  the  Medical  Depart- 
ment, but  all  in  the  military  service  should  have  some 
knowledge  as  to  the  methods  whereby  an  unsafe  water  may 
be  rendered  potable.  Moreover,  it  must  be  emphasized 
that,  once  purified,  it  must  be  so  maintained.  The  discus- 
sion of  these  methods  naturally  falls  under  two  heads,  namely, 
whether  the  supply  must  be  treated  on  a  large  scale  (as  in  a 
permanent  post)  or  on  a  small  one  (as  in  the  field  or  on  board 
a  transport). 

Methods  of  Purification  of  Water  on  a  Large  Scale 

(A)  Sedimentation. — This   consists   merely   in    affording 
opportunity  for  suspended  solids  to  settle  to  the  bottom  of 
large  tanks,  from  the  upper  parts  of  which  the  clear  water 
flows  or  is  piped.     Ordinary  reservoirs  utilize  this  principle 
in  addition  to  that  of  mere  storage. 

(B)  Precipitation. — The  addition  to  the  water,  in  settling 
tanks,  of  a  minute  amount  of  certain  chemicals  (notably  alum) . 
causes  the  formation  of  a  peculiar  gelatinous  precipitate, 
which,  sinking  slowly,  entangles  small  floating  earthy  parti- 


128  MILITARY  HYGIENE 

cles  and  even  bacteria,  and  carries  these  to  the  bottom.  As 
in  sedimentation,  the  clear  water  is  then  drawn  from  the  top 
of  the  tank. 

(C)  Filtration. — (1)  Slow  Sand:  This  is  carried  out  through 
beds  of  clean  fine  sand  and  gravel  3  or  more  feet  thick. 
Every  few  weeks  the  slimy  film  of  mud  and  vegetable  growth 
which  forms  on  the  surface  of  the  beds  must  be  scraped  off, 
as  it  interferes,  to  a  rapidly  increasing  degree,  with  the  rate 
of  filtration.     On  the  other  hand,  this  film  is  of  considerable 
value,  for  the  reason  that  harmless  germs  which  form  part 
of  it  assist  in  the  destruction  of  the  disease  germs.     On  this 
account  the  film  should  not  be  disturbed  except  when  it 
becomes  so  dense  as  to  interfere  with  a  reasonable  rate  of 
filtration.     If  the  water  is  very  turbid,   sedimentation  is 
practised  beforehand.     (2)  A  mechanical  filter  is  the  same  as 
a  slow  sand  one,  except  that  precipitation  is  employed  at 
the  same  time.     Alum  (f  to  1  grain  per  gallon)  is  added  to 
the  water  as  it  flows  upon  the  sand  bed.     Iron  with  lime 
may  be  substituted  for  alum.     This  form  of  filter  requires 
a  daily  cleansing.     Both  slow  sand  and  mechanical  filters 
are  very  effective,  as,  if  properly  constructed  and  operated, 
they  strain  out  about  98  per  cent,  of  the  bacteria  contained 
in  the  raw  water. 

(D)  Addition  of  Copper  Sulphate. — This  is  especially  ap- 
plicable where  the  minute  vegetable  growths  known  as  algae 
have  to  be  dealt  with  in  tanks  and  reservoirs.     One  part  of 
the  chemical  to  the  million  parts  of  water  is  effective  in 
checking  the  growth  of  these  plants  and  thus  removing  the 
fishy  taste  imparted  to  the  water  by  them. 


WATER-SUPPLY  129 

(E)  Chlorin  gas  has  the  property  of  destroying  bacteria 
in  water.     The  best  apparatus  for  its  use  is  that  devised  by 
Major  Darnall,  Medical  Corps,  United  States  Army.      In 
this  the  gas,  compressed  in  steel  drums,  is  mixed  with  the 
water  to  be  treated  as  it  flows  through  the  supply-pipe. 
The  apparatus  is  easily  operated,  effective,  and  economical. 
The  cost  is  about  40  cents  per  million  gallons. 

(F)  Ozone. — This  allotropic  modification  of  oxygen,  pro- 
duced in  the  usual  manner  by  non-luminous  electric  dis- 
charges in  dried  air,   is  a  very  efficient  germ  destroyer. 
When  mixed  with  the  water  as  this  passes  through  gravel 
filters,  it  quickly  and  thoroughly  destroys  dangerous  bacteria. 

(G)  Ultraviolet   Light. — The  chemical   rays  of  the  solar 
spectrum  have  been  found  to  be  destructive  to  germ  life, 
and  their  application    to    contaminated  water-supplies  is 
effective  in   rendering  these   safe  for  drinking  and   other 
purposes. 

Methods  for  the  Purification  of  Water  on  a  Small  Scale 

Removal  of  Objectionable  Substances. — This  means,  for 
our  purposes,  the  supply  of  a  safe  drinking-water  on  field 
service.  The  source  of  supply  may  be  pure,  in  which  case 
it  becomes  our  duty  so  to  maintain  it.  Certain  constitu- 
ents, while  perhaps  not  such  as  to  induce  disease,  may 
still  be  objectionable  and,  therefore,  require  removal  or 
alteration.  For  example,  the  water  may  be  very  hard, 
muddy,  or  unpleasant  in  taste.  If,  as  is  likely,  a  part  of  the 
hardness  is  temporary,  such  part  may  be  removed  by  boiling. 
A  muddy  water  may  be  clarified  by  sedimentation,  precipi- 


130  MILITARY  HYGIENE 

tation,  filtration,  or  a  combination  of  these  procedures.  In 
this  connection  it  is  useful  to  know  that  the  prickly  pear 
cactus,  which  grows  over  a  large  part  of  our  country,  will, 
if  bruised  and  thrown  into  a  vessel  of  muddy  water,  aid  in 
its  clarification.  Its  action  is  like  that  of  alum,  in  that  its 
juice  entangles  the  floating  solid  particles  and  sinks  with 
them  to  the  bottom.  An  unpleasant  taste  may  sometimes 
be  driven  off  by  boiling;  if  due  to  algae,  a  little  citric  acid 
will  dispel  it. 

Removal  of  Disease  Germs. — Disease  germs  are  removed 
or  destroyed  by  certain  of  the  measures  previously  out- 
lined or  by  others  to  be  described.  Thus,  sedimentation 
and  precipitation  will  remove  many  germs  along  with 
other  floating  particles  which  settle  to  the  bottom  of  the 
containing  vessel.  Apparatus  has  been  devised  for  the 
field  use  of  chlorin,  of  ozone,  and  even  of  ultraviolet  rays, 
but  these  up-to-date  methods  have  not  yet  assumed  a  prac- 
tical field  form,  and  it  is  not  likely  that  they  will  hereafter, 
for  the  reason  that  they  require  bulky  machinery  and 
impose  an  additional  strain  upon  an  already  excessive 
transport.  And  this  criticism  applies  to  water  carts  and 
wagons,  found  to  some  extent  in  foreign  armies  and  some- 
times recommended  for  our  own.  These  vehicles  are  wheeled 
filters  or  heat  sterilizers.  While  undoubtedly  desirable,  the 
increase  in  transportation  units  (one  or  more  to  a  regiment) 
renders  their  use  in  war  unlikely. 

Purification  in  the  Field. — There  are  three  methods  of 
purification  which  may  be  employed  in  the  field.  These 
are  chemical  treatment,  filtration,  and  the  use  of  heat. 


WATER-SUPPLY  131 

Chemical. — A  large  variety  of  substances  have  been  used 
at  different  times  for  the  rapid  chemical  disinfection  of 
water  by  individual  soldiers  on  field  service.  Some  of 
these — as  iodin  and  bromin — are  perfectly  efficient  when 
conditions  are  entirely  favorable,  but,  owing  to  difficulties 
of  supply  and  handling  or  lack  of  intelligence  in  their  use, 
they  cannot  be  relied  upon.  Permanganate  of  potassium- 
is  slow  in  action  and  uncertain  in  results.  The  bisulphate 
of  sodium  is  efficient,  but  not  suitable  for  prolonged  use. 
Chlorin  and  chlorids  impart  an  unpleasant  taste  to  the  water. 
And  thus  it  is  evident  that  chemical  sterilization  in  the  field, 
while  excellent  in  theory,  fails  in  practice.  We  are,  there- 
fore, in  the  present  state  of  our  knowledge  of  this  subject 
reduced  to  the  employment  of  two  measures,  namely,  filtra- 
tion and  the  use  of  heat. 

Filtration. — Filtering  material  and  methods  differ  in 
armies.  In  the  British,  German,  and  French  services  hol- 
low "candles"  composed  of  unglazed  porcelain  or  infusorial 
earth  are  employed.  The  water  is  driven  through  these  by 
means  of  a  small  force  pump.  Such  filters  are  fragile,  re- 
quire trained  care,  and  clog  quickly.  The  Japanese  employ 
the  Ishiji  filter  (Fig.  16),  an  inverted  cone  of  canvas,  whose 
two  spouts  are  plugged  with  sponge  and  powdered  charcoal, 
which  constitute  the  filtering  agents.  The  water  in  the  cone 
is  given  a  preliminary  chemical  treatment  with  permanganate 
of  potash  before  filtration  commences. 

Darnall  Filter. — Our  own  device,  but  little  more  complex 
than  the  Ishiji  and  decidedly  more  efficient,  is  the  Darnall 
siphon  filter  (Fig.  17).  Like  the  Japanese  filter,  it  em- 


132  MILITARY  HYGIENE 

ploys  precipitation  in  conjunction  with  the  filtration.     The 
chemical  agent  in  this  case  is  alum,  combined  with  sodium 


Fig.  16. — Ishiji  filter  (Japanese  model). 

bicarbonate.  The  complete  apparatus  weighs  52  pounds 
and  consists  of  the  following  parts: 

(A)  One  filter  tank,  galvanized  iron. 

(B)  Two  water  cans,  galvanized  iron. 

(C)  One  siphon  filter,  bent  perforated  pipe. 

(D)  Four  filter  cloths,  of  outing  flannel. 

In  addition,  the  apparatus  is  supplied  with  a  small  hand 
pump,  to  serve  as  a  siphon  primer;  a  brush  for  cleansing 
cloth  when  clogged;  and  a  measure  for  the  chemical. 


WATER-SUPPLY 


133 


All  other  parts  pack  inside  the  tank.  To  operate  the  filter 
proceed  as  follows:  (1)  Wrap  a  filter  cloth  around  the  wires 
of  the  siphon. 

c 


—  ™                     "~^1         I 

CT 

V           C 

X 

i 

'  C 

f        CKATE 

-\  r 

M             1 

B 


Fig.  17. — Darnall  filter,  showing  method  of  operation. 

(2)  Sterilize  the  siphon  by  putting  it  in  one  of  the  cans, 
filling  the  latter  with  boiling  water,  and  drawing  off  the 
water  by  starting  the  siphon. 

(3)  Fill  the  other  can  with  the  water  to  be  treated,  stir 
in  a  measure  of  the  alum-soda  powder,  and  empty  the  can 


134 


MILITARY  HYGIENE 


into  the  tank.  Repeat  until  the  tank  is  full,  then  trans- 
fer the  siphon  to  the  tank  and  start  it  with  the  pump.  Lift 
the  siphon  and  brush  off  its  cloth  whenever  it  becomes  clogged 
with  sediment.  With  clear  water  the  filter  will  furnish  50 
gallons  of  the  purified  product  per  hour,  a  quantity  sufficient 
to  fill  200  canteens.  If  the  water  is  muddy,  the  amount  is 
considerably  reduced. 


Fig.  18. — Barrel  filter  sunk  in  spring. 

Improvised  Filter. — A  filter  may  be  improvised  by  sinking 
a  barrel  or  box  in  the  source  of  field  supply,  (spring  or  margin 
of  stream),  placing  a  smaller  cask  or  box  within,  and  filling 
the  intervening  space  with  sand.  The  outer  barrel  should 
be  pierced  at  or  near  the  bottom,  the  inner  one  near  the  top, 
with  a  number  of  small  holes  (Fig.  18). 

Success  by  filtration  methods  is  relative  rather  than  ab- 
solute. 


WATER-SUPPLY  135 

The  destruction  of  bacteria  in  water  (sterilization)  by 
heat  is  accomplished:  (a)  By  distillation;  (6)  by  boiling;  or 
(c)  by  raising  the  temperature  to  a  point,  short  of  212°  F., 
which  is  fatal  to  the  germs.  Distillation  is  employed  for 
small  communities — as  on  shipboard  and  at  certain  Philip- 
pine stations — but  is  not  practicable  in  the  field.  A  tem- 
perature of  176°  F.,  maintained  for  a  few  seconds,  is  suffi- 
cient to  kill  the  germs  of  diseases  transmitted  by  drinking- 
water.  This  principle  is  utilized  in  the  Forbes  sterilizer,  of 
which  many  have  been  supplied  to  our  service.  These  have 
been  much  used  in  the  past  and  have  filled  an  important 
place,  but  it  is  doubtful  if  they  will  be  issued  in  the  future, 
at  least  for  field  service.  Their  defects  are:  weight;  compara- 
tive fragility;  easy  derangement;  necessity  for  skilled  at- 
tendance; risk  of  imperfect  sterilization.  The  fuel  ordinarily 
used  is  kerosene,  and  the  difficulty  in  the  supply  of  this 
material  constitutes  a  further  defect.  This  objection  has 
been  met  by  the  invention  of  a  wood-burning  attachment, 
thus  adapting  it  to  the  local  fuel  supply.  The  weight  of 
the  apparatus,  with  this  attachment  and  two  nested  barrels, 
is  nearly  180  pounds,  and  at  least  three  of  the  sterilizers 
are  required  for  the  needs  of  a  regiment.  The  apparatus 
is  of  value  in  the  supply  of  a  safe  drinking-water  for  per- 
manent camps  and  outlying  stations.  By  reference  to  Fig. 
19,  which  shows  the  United  States  Army  type  with  wood- 
burning  attachment,  the  sterilizer  is  seen  to  be  a  slender 
upright  machine  of  copper  and  brass.  The  base  is  a  kero- 
sene reservoir  with  a  small  compression  pump  to  feed  the 
"Primus"  burner.  By  an  ingenious  arrangement,  whereby 


136 


MILITARY  HYGIENE 


the  raw  and  sterilized  waters  are  separated  merely  by  a 
thin  metal  partition,  the  former  is  gradually  heated  and  the 
latter  cooled  by  their  interaction.  Thus  the  water  when  it 


Fig.    19. — Forbes'    sterilizer    with    "  wood  -burning   attachment"    and 
" barrel  accessory." 

leaves  the  sterilizer  is  but  4  degrees  warmer  than  when  it 
entered. 

The  Forbes  company  has  devised  a  large  sterilizer,  capable 
of  yielding  400  gallons  per  hour,  and  mounted  on  the  running 


WATER-SUPPLY  137 

gear  of  an  escort  wagon.  If  such  a  wagon  actually  accom- 
panied a  moving  command,  it  should  be  able  to  supply  a 
brigade.  The  Germans,  French,  and  British  have  experi- 
mented with  large  portable  sterilizers  operating  on  the 
heat  exchange  principle  utilized  by  the  Forbes,  but  have  not 
found  them  practicable  for  field  service,  for  reasons  already 
cited. 

Boiling. — The  safest,  simplest,  and  most  uniformly  avail- 
able method  of  water  sterilization  is  boiling.  This  can  be 
done  in  the  company  kettles  at  night  after  supper,  and 
the  water  is  cooled  and  ready  for  the  canteens  by  morning. 
Or,  if  the  kettles  are  not  available,  each  soldier  may  boil  his 
own  supply  in  cup  or  new  model  canteen.  Even  this  pro- 
cedure has  certain  disadvantages,  which,  fortunately,  are 
minor  ones.  It  is  an  inconvenience;  the  water  cannot  be 
used  until  it  cools;  the  dissolved  air  is  driven  off  and  the 
taste  thereby  made  insipid.  As  for  the  last  objection,  the 
water  may  be  re-aerated  by  pouring  it  from  one  vessel  to 
another  a  few  times. 

Ice  taken  from  an  impure  source  may  contain  dormant 
disease  germs.  Freezing  does  not  always  kill  them  and  they 
may  become  active  when  the  ice  is  melted,  but  a  greater 
danger  results  from  the  careless  handling  of  this  substance, 
contact  with  dirty  hands  or  other  infected  objects  often 
adding  to  a  pure  ice  the  dangerous  micro-organisms.  Unless 
one  is  sure  of  source  and  handling,  it  is  wise  not  to  place  ice 
in  the  beverage,  but  to  cool  the  latter  by  applying  the 
chilling  agent  to  the  outside  of  the  container. 

If  in  Doubt,  Purify. — It  is  possible  that  antityphoid  vac- 


138  MILITARY  HYGIENE 

cmation  may  be  found  to  confer  such  immunity  as  to  render 
the  sterilization  of  water  superfluous,  at  least  so  far  as  that 
disease  is  concerned.  If  such  proves  to  be  the  case,  a  great 
source  of  anxiety  would  be  removed,  as  well  as  the  necessity 
for  bulky  apparatus  and  expenditure  of  time  and  trouble. 
But,  pending  such  finding,  it  must  be  remembered  that  no 
sure  and  rapid  test  as  to  purity  exists.  So  the  word-pictures 
drawn  by  certain  correspondents  during  the  Russo-Japanese 
War,  of  medical  officers  hurrying  in  front  of  marching  com- 
mands, armed  with  microscopes  and  chemical  sets  for  ex- 
amination of  waters  prior  to  the  arrival  of  troops,  are  absurd- 
ities. A  careful  inspection  of  the  source  and  surroundings 
of  the  water-supply,  with  a  view  to  determining  probable 
contamination,  is  our  best  guide.  The  rule  to  be  followed 
is:  If  in  doubt,  purify. 


CHAPTER  IX 
FOODS  AND  THEIR  PREPARATION 

Cells. — Man,  in  common  with  all  complex  living  organ- 
isms, is  made  up  of  a  vast  assemblage  of  minute  structural 
units,  which,  for  lack  of  a  better  name,  are  called  cells. 
In  order  that  these  cells  may  possess  certain  properties  which 
are  necessary  to  the  well-being  of  the  body,  they  must  have 
food. 

Properties  of  Cells. — The  properties  incident  to  healthy 
cells  are:  (a)  growth;  (6)  repair;  (c)  reproduction;  (d)  the 
storage  of  materials  which  are  capable  of  being  utilized  as 
producers  of  heat  or  other  forms  of  energy  (i.  e.,  fuel);  (e) 
the  actual  production  of  energy  by  the  burning  up  (oxida- 
tion) of  such  fuel. 

Definition  of  Food. — In  its  general  sense,  food  may  be 
taken  to  mean  anything  which  nourishes  the  body.  Such 
a  broad  definition  would  include  the  oxygen  derived  from  the 
air  we  breathe.  In  its  ordinary  usage  the  term  refers  to 
materials  voluntarily  introduced  into  the  body  to  support 
life. 

Bodily  Processes. — In  the  normal  processes  of  the  body 
tissues  must  be  grown  or  rebuilt;  waste  must  be  repaired; 
energy  must  be  created;  heat  must  be  supplied.  Woodhull 
says:  "Life  is  essentially  a  form  of  motion.  It  is  maintained 
by  the  rejection  of  old  and  wornout  particles  and  by  the 

139 


140  MILITARY  HYGIENE 

assimilation  of  new  particles  to  replace  these  or  to  develop 
the  body  still  further."  The  new  particles,  introduced  as 
food  in  a  certain  form  and  altered  by  the  chemistry  of  the 
body  according  to  its  needs,  are  utilized  thus:  (a)  To  form 
tissues;  (6)  to  make  repairs;  (c)  to  use  as  fuel;  (d)  to  develop 
the  activity  of  muscles  and  other  structures;  (e)  to  store  up 
as  food  for  future  use. 

Chemical  Composition  of  Body. — Four  elements — oxygen, 
hydrogen,  carbon,  and  nitrogen — are  necessary  ingredients 
of  all  the  tissues  of  the  body.  Nitrogen  is  essentially  a  tis- 
sue builder,  acting  under  heads  (a)  and  (6)  above.  The 
other  three  elements  are  force  producers  and  serve  the 
purposes  of  the  body  as  represented  by  (c),  (d),  and  (e).  It 
is  obvious,  therefore,  that  food  must  likewise  contain  these 
elements  in  proportions  at  least  approximating  the  needs 
of  the  body.  Certain  other  elements  are  found  in  varying 
quantities  in  the  tissues,  but  for  the  purposes  of  this  dis- 
cussion they  need  not  be  considered  here. 

The  great  bulk  of  our  food  consists  of  substances  con- 
taining carbon,  hydrogen,  and  oxygen;  in  other  words,  the 
force  producers.  These  substances  are  completely  oxidized  in 
the  system,  their  end-products  being  carbon  dioxid  and  water. 

Nitrogenous  Foods. — The  nitrogen-containing  foods— 
that  is,  the  tissue  builders — leave  a  residue  of  waste  material 
in  the  form  of  urea  and  like  substances.  As  Hutchinson  ex- 
presses it,  "The  body  does  not  reduce  all  its  fuel  to  ashes. 
Some  of  it  is  only  charred."  Certain  physiologists  maintain 
that  a  large  excess  of  such  nitrogenous  foods  is  ordinarily 
taken  and  that  these  impose  undue  strain  upon  the  organ- 


FOODS  AND  THEIR  PREPARATION 


141 


ism.  On  the  other  hand,  men  engaged  in  severe  exertion 
draw  upon  their  reserve  stores,  especially  of  nitrogen,  unless 
this  is  amply  provided  in  the  food.  It  is  at  least  certain 
that  we  cannot  accept  as  final,  laboratory  experiments  which 
are  greatly  opposed  to  the  experience  of  centuries. 

Classes  of  Foods. — Substances  used  as  food  by  mankind 
naturally  fall  under  three  groups,  in  accordance  with  their 
chemical  characteristics.  These  groups  are  proteins,  carbo- 
hydrates, and  fats.  The  proteins  are  the  nitrogenous  foods, 
being  made  up  of  carbon,  hydrogen,  oxygen,  and  nitrogen. 
Carbohydrates  and  fats  contain  the  first  three  of  these  ele- 
ments only.  In  addition  to  the  true  foods  just  mentioned, 
there  are  other  substances  equally  vital  to  the  life  of  the 
cells,  notably  water  and  mineral  salts.  Foods  are  thus 
seen  to  be  derived  from  animal,  vegetable,  and  mineral 
sources,  and  may  be  classified  as  follows: 

Classification  of  Materials  Used  as  Foods 


Derivation. 

Type. 

Class. 

Examples. 

Function. 

Nitrogenous. 

Proteins. 

Meats,  fish,  fowl,  eggs, 
milk,     beans,     peas, 

Tissue 
builders. 

gram. 

Organic  .  .  . 

Non  -  nitrog- 
enous. 

(a)         Carbohy- 
drates (sugars 
and  starches). 

(6)     Fats     (ani- 
mal   fats    and 
vegetable 
.      oils). 

Potato,      rice,      corn- 
starch,  sugars  (cane, 
beet,  milk),  honey. 

Meat      fats,      butter, 
cream,  olive  oil,  choc- 
olate.                             J 

Work    and 
fuel    pro- 
ducers. 

Inorganic  .  . 

f  Water. 

) 

Tissue 

\  Mineral  salts. 

Iron,  phosphorus,  lime.  J 

builders. 

Materials  Accessory  to  Foods. — While  the  above  furnishes 
a  complete  classification  of  foods,  man  makes  use  of  cer- 


142  MILITARY  HYGIENE 

tain  accessory  materials  which,  though  they  do  not  yield 
energy,  are  valuable  in  association  with  foods  proper.  Such 
are  condiments,  flavoring  extracts,  bakers'  chemicals,  and 
stimulants  like  tea  and  coffee.  For,  in  diet,  nutritive 
values  are  not  the  only  consideration;  flavor  and  variety 
also  are  important. 

Functions  of  Different  Classes. — The  chief  function  of 
the  proteins  in  the  food  is  to  nourish  the  muscles.  Carbo- 
hydrates furnish  heat  and  muscular  activity  and,  in  addi- 
tion, are  stored  up  as  reserve  fuel.  This  reserve  occurs  in 
two  forms:  first,  as  glycogen  or  "animal  starch";  second,  as 
fat.  Glycogen  is  contained  in  the  liver  and  the  muscles, 
and  there  may  be  enough  of  it  to  supply  energy  for  four  or 
five  days  in  the  absence  of  all  food.  Fats,  like  carbohydrates, 
are  work  and  heat  producers,  but,  oddly  enough,  they  do 
not  form  fats  in  the  human  body.  As  their  functions  are 
nearly  identical,  carbohydrates  and  fats  are  capable  of 
replacing  one  another  in  the  diet  to  a  considerable  extent, 
though  the  body  burns  carbohydrates  by  preference.  Thus, 
Arctic  dwellers  derive  their  energy  chiefly  from  fatty  foods; 
Tropic  inhabitants,  from  starchy  ones.  There  is  a  great 
difference  in  peoples  as  to  character  and  preparation  of 
foods.  This  is  the  result  of  training  and  habit  as  well  as  of 
necessity,  but  seems  of  minor  importance  so  long  as  the 
nutritious  principles  are  present  in  proper  amounts  and 
proportions.  A  marked  military  advantage  inheres  in  this 
fact,  as  a  nation  whose  food  is  of  little  variety  and  small 
bulk  can  dispense  with  much  transportation  and  is  less 
dependent  thereupon. 


FOODS  AND  THEIR  PREPARATION  143 

Calories. — The  potential  energy  contained  in  any  food  sub- 
stance is  expressed  in  calories.  A  calorie  is  a  heat  unit:  it 
is  the  amount  of  heat  required  to  raise  one  kilogram  of  water 
from  zero  to  1°  C.  Thus, 

1  gram  of  protein  yields  4  calories. 

1  gram  of  carbohydrate  yields  4  calories. 

1  gram  of  fat  yields  9.4  calories. 

Fat,  though  economical  in  bulk  and  cost,  cannot  ordi- 
narily be  freely  used  to  replace  carbohydrate  because  of 
digestive  limitations,  so  foods  of  the  latter  class  are  the 
ones  chiefly  called  upon  to  furnish  energy.  They  constitute 
the  bulky  part  of  the  diet. 

Salts.— The  inorganic  salts  needed  in  the  diet  are  con- 
tained in  sufficient  amounts  in  ordinary  food.  The  only 
one  which  must  be  specially  supplied  is  sodium  chlorid 
(common  salt). 

Water. — The  body  is  mainly  water,  which  makes  up 
nearly  two-thirds  of  the  total  weight.  The  food  must, 
therefore,  contain  a  large  amount  of  water  to  replace  con- 
stant losses. 

Ration. — A  ration  is  the  food  allowance  for  the  subsist- 
ence of  one  person  for  one  day.  The  term  "balanced 
ration,"  often  heard  nowadays,  means  one  by  which  perfect 
nutrition  is  secured,  without  excess  of  any  kind  of  food. 
Certain  standards  have  been  arrived  at  by  experts,  fixing 
the  quantity,  expressed  in  calories,  of  each  class  of  a  ration 
for  individuals  in  different  environments  and  under  vary- 
ing circumstances  of  muscular  work  and  other  occupations. 
Such  standards  are  but  approximate  and  of  little  concern  to 


144  MILITARY  HYGIENE 

us  here.  It  may  be  of  use  to  us  to  know  that  a  garrison 
ration  should  have  an  energy-yielding  value  of  about  3000 
calories  and  a  field  ration  of  not  less  than  4000  calories. 

Diet  in  General. — The  relative  digestibility  of  food 
stuffs  differs  markedly,  but  the  ordinary  meal  is  usually 
completely  digested  in  four  to  five  hours.  In  general,  meats 
are  more  readily  assimilated  than  vegetables.  It  is  probably 
true  that  too  much  meat  is  taken  by  many  individuals,  and 
that  the  protein  excess  tends  to  produce  irritant  waste 
matters  which  are  likely  to  cause  gout,  Bright 's  disease,  and 
arterial  changes,  but  civilized  man  has  accustomed  himself 
to  meats,  and  their  moderate  use  is  believed  to  be  to  his 
advantage.  Except  by  a  few  extremists,  it  is  generally 
admitted  that  a  mixed  diet  is  the  rational  one.  Man  is 
extraordinarily  adaptable  in  matters  of  food,  just  as  he  is  in 
other  particulars  (as  climate).  With  respect  to  the  quantity 
of  food  taken,  we  know  that  moderate  amounts  in  excess  of 
a  balanced  ration  are  stored  up  in  the  body  as  a  reserve. 
Militarily,  this  is  likely  to  be  of  the  utmost  value  at  times 
when  the  soldier,  lacking  food,  must  subsist  in  whole  or  in 
part  upon  his  own  tissues. 

Milk. — Certain  forms  of  the  commoner  foods  deserve 
separate  mention.  Milk  is  perhaps  the  most  important  of 
all  foods,  since  it  is  the  only  one  capable  of  supporting  life 
by  itself.  It  is  not  a  perfect  food,  but  approximates  one 
more  nearly  than  any  other  substance.  In  the  absence  of 
cows,  the  milk  of  goats,  mares,  and  domesticated  buffaloes 
— as  the  Philippine  carabao — is  useful  and  fairly  nutritious. 
Comdensed  cream  and  milk  are  valuable  when  the  fresh 


FOODS  AND  THEIR  PREPARATION  145 

product  is  not  obtainable.  Milk  is  often  adulterated  in  one 
or  both  of  two  ways:  by  the  removal  of  cream  or  the  addi- 
tion of  water.  It  may  transmit  the  germs  of  disease,  such 
as  typhoid  fever  and  tuberculosis.  It  absorbs  odors  readily 
and  should  not  be  placed  in  a  refrigerator  with  strong- 
smelling  substances,  such  as  onions,  stale  cheese,  and  tainted 
meat.  Its  products  are  numerous  and  valuable  and  include 
butter,  cheese,  buttermilk,  koumiss,  soured  milk,  and  whey. 
Cheese  is  a  highly  nutritious  food  and  might  advantageously 
be  substituted  for  bacon  as  an  occasional  issue.  Milk  arti- 
ficially soured  by  the  addition  of  a  lactic-acid-forming  bacil- 
lus is  not  now  thought  to  prolong  human  life,  though  it  is  a 
nutritious  and  useful  beverage. 

Eggs  contain  all  the  ingredients  necessary  to  support  life, 
though  not  in  proper  proportions.  The  fresher  they  are, 
the  more  digestible.  Cold-storage  eggs  preserve  their  fresh- 
ness fairly  well  for  a  month  or  two.  After  that  they  acquire 
a  taste  and  odor  which  distinguishes  them  from  the  fresh 
article,  though  they  are  still  useful  for  baking  purposes. 
They  are  sometimes  preserved  by  desiccation,  in  which  form 
they  are  readily  portable  and  serviceable  for  cooking. 

Beef. — Meats  furnish  us  with  our  chief  supply  of  nitro- 
gen. They  are  popularly  classified  as  flesh,  fowl,  and  fish. 
Of  all  foods  under  this  head,  beef  is  the  most  important. 
Since  it  constitutes  so  essential  a  part  of  the  ration,  ability 
to  judge  of  its  freshness  and  freedom  from  disease  is  of  great 
practical  value.  The  appearance  of  fresh  cuts  cannot  be 
accurately  described  and  a  knowledge  of  their  characteristics 

should  be  gained  by  study  of  the  meats  themselves.     Good 
10 


146  MILITARY  HYGIENE 

beef  is  bright  red  in  color.  A  dark  purplish  hue  suggests 
that  the  animal  has  died  from  disease  or  has  been  imper- 
fectly bled;  this  latter  is  objectionable,  as  it  predisposes  to 
decomposition.  The  odor  should  not  be  disagreeable,  al- 
though refrigerated  beef,  especially  when  the  sacking  has 
just  been  removed,  often  has  a  cadaveric  smell.  Undue 
softness  and  stickiness  of  the  freshly  cut  surface,  or 
the  presence  of  pus,  indicates  decay.  An  early  evidence 
of  decomposition  is  furnished  by  thrusting  a  knife  or 
skewer  deeply  into  the  meat  and  smelling  it  on  with- 
drawal. If  decay  has  commenced,  a  putrid  odor  is 
observable. 

The  bones  make  up  about  20  per  cent,  of  the  weight  of  the 
carcass  and  5  per  cent,  more  is  wasted  in  trimming  the  cuts. 
Cattle  on  the  hoof  accompanying  a  marching  army  are  poor 
in  flesh  and  their  meat  is  tough  and  stringy.  In  these  days 
of  refrigeration  it  is  unusual  to  obtain  a  supply  of  freshly 
slaughtered  beef. 

Refrigeration. — Actual  freezing  of  beef  causes  some  de- 
terioration, and  its  temperature  in  cold  storage  should 
preferably  be  maintained  at  a  point  just  above  freezing. 
Fresh  beef  issues  in  the  United  States  have  usually  been  in 
cold  storage  for  about  a  month;  those  in  the  Philippines  at 
least  two  or  three  times  that  long. 

Preserved  Meats. — Aside  from  cold  storage,  there  are 
four  methods  used  in  preserving  meats.  These  are:  (a) 
curing;  (b)  sterilizing  by  heat  and  then  canning;  (c)  drying; 
(d)  treatment  with  chemicals.  Meats  are  cured  with  salt, 
wood  smoke,  vinegar,  or  sugar.  A  pound  of  canned  beef 


FOODS  AND  THEIR  PREPARATION  147 

has  a  nutritive  value  about  one-third  greater  than  an  equal 
weight  of  the  fresh  meat.  Canned  beef  is  supplied  in  two 
forms  for  our  ration,  to  be  used  when  fresh  meat  is  not  ob- 
tainable. These  forms  are  roast  beef  and  corned  beef  hash. 
The  latter  is  much  liked;  the  former,  though  wholesome,  is 
made  from  the  inferior  cuts  and  is  rather  tough  and  flavor- 
less. Chemical  preservatives  (commonly  borax  and  sodium 
sulphite)  are  objectionable,  and  the  use  of  meats  so  treated 
should  be  discouraged. 

Bacon,  the  cured  side  of  the  hog,  is  an  even  better  food 
for  the  military  ration  than  beef.  Its  palatability,  digesti- 
bility, portability,  and  keeping  qualities  all  combine  to 
render  it  our  chief  reliance  in  the  field.  Its  fat  is  pecu- 
liarly assimilable  and  yields  more  energy  than  any  other 
food. 

Meat  Juices,  Extracts,  and  Powders. — The  juices  of  fresh 
meats  possess  much  nutritive  value;  on  the  other  hand,  meat 
extracts  are  nearly  valueless  as  food,  though  they  are  useful 
as  stimulants,  like  coffee  and  tea.  Meat  may  be  dried  and 
powdered,  and,  if  well  prepared,  is  fairly  nutritious  in  this 
form.  Having  the  advantage  of  small  bulk,  this  may  be 
found  suitable  for  military  use. 

Unusual  Meats. — The  objection  to  horseflesh  and  other 
unusual  meats  is  chiefly  sentimental.  It  is  well  known  that 
certain  peoples  find  such  animals  as  dogs  and  rats  a  valuable 
addition  to  their  diet,  Meat  from  diseased  animals  is 
ordinarily  objectionable,  but  in  time  of  siege  or  other  ex- 
tremity it  is  better  to  use  it  than  to  go  hungry.  In  prepar- 
ing such  meat  for  food,  the  animal  should  be  thoroughly 


148  MILITARY  HYGIENE 

bled  and  the  internal  organs,  together  with  all  obviously 
diseased  parts,  rejected.  Cooking  should  be  thorough. 

Flour. — Of  food  stuffs  derived  from  vegetable  sources, 
wheat  flour  is  undoubtedly  most  important  to  us,  as  from  it 
"the  staff  of  life"  is  made.  There  is  a  great  difference  in 
flours,  according  to  the  quality  of  the  grains  from  which 
they  are  made,  the  excellence  of  the  milling,  the  age  of 
the  product,  and  the  method  of  storage.  If  (as  a  result  of 
age,  dampness,  or  general  inferiority)  chemical  changes  en- 
sue, flour  is  invaded  by  minute  insects  (mites  and  weevils). 
Flour  absorbs  strong  odors  readily,  wherefore  such  substances 
as  kerosene,  tobacco,  and  onions  should  not  be  stored  near  by. 

Bread. — The  baking  of  bread  is  so  important  a  part  of 
the  rationing  of  soldiers  that  all  officers  should  have  a 
knowledge  of  its  principles.  Briefly,  the  process  consists 
of  the  following  steps :  First,  making  a  dough  by  the  mixture, 
with  the  flour,  of  water,  salt,  and  yeast.  Yeast  is  a  ferment 
which  produces  carbon  dioxid.  Second,  allowing  the  fer- 
ment to  work  upon  the  dough  for  some  hours,  during  which 
time  a  considerable  increase  in  bulk  takes  place  as  a  result 
of  the  development  of  the  CCV  Third,  baking  the  dough 
into  loaves.  The  changes  induced  in  the  flour  by  these 
means  are:  (a)  Uniform  diffusion  of  the  gas,  thus  forming 
bubbles  throughout  the  bread  and  making  it  light;  (6)  the 
coagulation  of  the  gluten  (the  protein  component  of  the 
flour),  which  binds  the  loaf;  (c)  the  conversion  of  some  of  the 
starch  into  sugar  and  other  readily  digestible  substances. 
Bread  may  also  be  made  by  generating  the  necessary  car- 
bon dioxid  with  a  baking  powder  or  by  forcing  the  pure  gas 


FOODS  AND  THEIR  PREPARATION  149 

into  the  dough.  Bread  which  has  become  sour  or  stale  may 
be  made  palatable  by  serving  as  toast. 

Beans  contain  a  considerable  proportion  of  nitrogen,  and 
are,  therefore,  capable  of  replacing  meats  to  some  extent. 
They  are  nutritious  and  constitute  one  of  the  staples  of  the 
field  ration.  They  are,  however,  hard  to  cook  and  difficult 
of  digestion.  The  old  army  saying,  "Beans  kill  more  than 
bullets,"  is  a  tribute  to  their  power  for  evil  when  they  are 
imperfectly  prepared.  The  dry,  issue  beans  must  be  soaked 
in  warm,  soft  water  for  twelve  hours  and  then  cooked  for 
several  hours  more.  The  trained  army  cook  knows  how  to 
prepare  them  properly.  A  plate  of  beans  has  the  approxi- 
mate food  value  of  one  of  meat  and  potatoes. 

Potatoes  are  valuable,  as  the  large  amount  of  starch  which 
they  contain  is  readily  digestible,  and  the  modes  of  prepa- 
ration are  so  variable  that  one  does  not  tire  of  this  vegetable. 

* 

The  outer  layers  of  the  potato  are  the  most  nutritious,  and 
it  is,  therefore,  desirable  to  scrape  away,  rather  than  cut, 
the  peel. 

Rice  constitutes  the  staple  food  of  a  majority  of  the 
earth's  inhabitants.  But  though  the  teeming  millions  of 
tropical  and  subtropical  lands  find  it  a  necessity,  it  has  never 
become  very  popular  with  dwellers  in  temperate  climes. 
Nevertheless,  it  is  a  valuable  starchy  food  and  deserves  our 
better  acquaintance. 

Sugar  is  of  especial  value,  because  it  is  so  readily  avail- 
able for  use  by  the  system.  It  needs  but  little  change  in 
the  chemistry  of  the  body  before  it  becomes  capable  of 
absorption  and  utilization. 


150  MILITARY  HYGIENE 

Fruits  are  useful  for  their  content  of  vegetable  acids,  su- 
gar, and  salts.  The  acids  supply  a  bodily  need,  as  shown 
by  the  fact  that,  when  they  are  lacking,  scurvy  develops. 
The  most  common  acids  of  this  class  are  citric  (from  lemons, 
oranges,  and  limes);  acetic  (from  vinegar);  tartaric  (from 
grapes);  malic  (from  apples,  tomatoes,  and  pears).  Bana- 
nas, dates,  and  figs  contain  much  nutriment,  and  are  widely 
used  as  food  staples  wherever  they  are  native  to  the  soil. 
Green  vegetables  are  of  value  for  much  the  same  reasons 
as  fruits.  Though  most  of  them  contain  but  small  amounts 
of  nutritive  principles,  their  acids  and  salts,  their  appetizing- 
flavors,  and  the  variety  they  impart  to  the  diet  make  them 
a  very  important  part  of  the  ration.  The  essential  food 
principle  in  staple  vegetables  is  starch. 

Coffee. — The  American  soldier  is  very  fond  of  coffee, 
and  though,  as  already  explained,  it  does  not  yield  energy, 
its  agreeable  flavor  and  its  ability  to  sustain  flagging  powers 
make  it  of  much  worth.  Such  being  the  case,  company 
officers  should  insist  that  it  be  properly  made,  for,  as  a  rule, 
it  is  spoiled  by  carelessness  or  ignorance.  The  coffee  bean, 
after  roasting  and  grinding,  soon  loses  the  delicacy  of  its 
flavor  unless  kept  in  an  airtight  container.  It  is,  therefore, 
desirable  to  use  freshly  roasted  and  ground  coffee  in  garri- 
son. In  the  field,  where  it  is  usually  impracticable  thus  to 
prepare  the  raw  bean,  care  should  be  taken  to  keep  the 
ground  coffee  in  a  tin  with  tightly  fitting  top. 

The  average  cook  makes  the  coffee  too  weak  and  drives 
off  the  fine  aroma  by  prolonged  boiling.  Such  cooks  often 
prepare  the  beverage  hours  before  it  is  to  be  used.  By 


FOODS  AND  THEIR  PREPARATION  151 

insisting  that  it  shall  be  freshly  made,  of  fresh  materials,  in 
a  clean  vessel  and  boiled  but  a  minute,  its  best  qualities  of 
flavor,  odor,  and  activity  are  preserved. 

Tea. — Oddly  enough,  though  our  Anglo-Saxon  relatives, 
the  English,  are  extremely  fond  of  tea,  the  average  American 
soldier  does  not  care  for  it.  Its  effect  upon  the  body  is 
practically  identical  with  that  of  coffee,  and  as  its  bulk 
and  weight  are  much  less,  its  -  military  value  is  superior. 
Weak,  cold  tea  is  very  palatable  and  makes  an  excellent 
beverage  with  which  to  fill  the  (aluminum)  canteen.  The 
Japanese  and  the  Russians  drink  tea  almost  to  the  exclusion 
of  water,  which  fact  is  said  to  explain  the  relative  exemption 
of  their  armies  from  water-borne  diseases  in  the  Manchurian 
campaign  of  1904.  Tea  should  never  be  boiled.  The  leaves 
are  dropped  into  freshly  boiled  water,  and,  after  a  minute 
or  two,  the  beverage  is  (preferably)  poured  from  the  leaves 
into  another  vessel.  Utensils  employed  in  making  tea  should 
be  of  some  material  which  is  resistant  to  tannin  (such  as 
silver,  china,  agateware,  or  aluminum),  for  the  leaves 
contain  a  large  proportion  of  this  acid,  which  promptly 
attacks  tin  or  iron.  If  allowed  to  stand  on  the  leaves  for 
some  time,  much  of  the  tannic  acid  will  be  extracted,  mak- 
ing the  beverage  black  and  bitter. 

Although  not  strictly  necessary,  it  is  desirable  that  cooks 
should  have  some  knowledge  of  the  processes  of  nutrition 
and  of  food  values.  Raw  materials  of  the  best  quality  are 
often  ruined  in  the  cooking.  On  the  other  hand,  a  skilled 
cook  may  prepare  inferior  food  stuffs  so  that  they  are  savory 
as  well  as  nutritious. 


152  MILITARY  HYGIENE 

Cooking  of  Meats. — The  effects  of  cooking  meats  are  to 
render  them  more  palatable  and  to  destroy  germs,  though 
the  process  does  not  always  increase  digestibility.  The 
principal  methods  of  preparation  of  such  foods  are: 

(A)  Soups  and  Broths. — These  are  made  by  soaking  the 
meat,  cut  up  into  inch  cubes,  in  cold  water  for  an  hour, 
then  cooking  slowly.     The  object  here  is  to  extract  the 
nutritious  juices  from  the  meat.     Bones  should  be  broken 
up  and  cooked  in  soup  for  the  sake  of  the  marrow,  which  is 
very  rich. 

(B)  Stewing  is  like  soup  making,  except  that  the  meat  is 
not  soaked  before  cooking,  very  little  water  is  used,  and 
vegetables  are  usually  added. 

(C)  In  boiling,  the  entire  piece  of  meat  is  plunged  at  once 
into  boiling  water,  in  order  to  coagulate  the  surface  and 
thus  prevent  the  juices    from    escaping.      Thereafter  the 
cooking  should  be  continued  at  a  lower  temperature. 

(D)  The  principle  of  roasting  is  the  same  as  that  of  boil- 
ing, that  is,  the  meat  is  first  exposed  to  a  high  temperature, 
to  cause  prompt  coagulation  of  the  surface  and  to  keep  the 
juices  within.     After  this  is  accomplished  the  temperature 
of  the  oven  is  reduced  and  the  meat  frequently  "basted" 
with  the  pan  juices. 

(E)  In  broiling,  the  same  effect  of  retention  of  juices  is 
produced  by  exposing  the  meat  to  an  open  fire.     This  method 
produces  especially  agreeable  flavors. 

(F)  Last  and  least  desirable  comes  frying.    This  is  ac- 
complished by  dropping  the  meat  into  hot  fat,  which  promptly 
seals  the  surface.    But,  unless  the  fat  is  very  hot  and  the 


FOODS  AND  THEIR  PREPARATION  153 

work  skilfully  done,  the  fat  will  penetrate  the  meat,  making 
it  greasy  and  hard  to  digest. 

Cooking  of  Vegetables. — Most  vegetable  foods  require 
cooking,  because  the  cellulose  which  encloses  their  starch 
granules  is  practically  incapable  of  digestion  by  man.  The 
raw  starch,  too,  must  be  softened.  Cooking  breaks  up  the 
cellulose  and  enables  the  digestive  fluids  to  act  upon  the 
starch. 

Temperature  in  Cooking. — In  all  forms  of  cooking  the 
temperature  should  be  kept  fairly  low — below  170°  F. — 
except  for  the  short  preliminary  treatment,  where  necessary, 
to  seal  the  exterior.  Company  cooks  must  be  frequently 
cautioned  and  inspected  concerning  this  point. 

The  United  States  Army  ration  is  generous  and  elastic, 
and  savings  therefrom,  with  provision  for  a  company  fund, 
make  it  still  more  so.  The  average  soldier  in  our  service 
gets  food  of  higher  quality,  greater  variety,  and  superior 
preparation  than  he  has  been  accustomed  to  in  civil  life. 
This,  combined  with  his  military  exercises,  regular  habits, 
and  general  hygienic  conditions,  causes  marked  gains  in  the 
weight  and  strength  of  recruits.  The  British  military  sani- 
tarian, Melville,  strongly  endorses  a  regimental  or  battalion 
system  of  messing  as  being  more  cleanly,  causing  less  waste, 
and  simplifying  the  removal  of  refuse.  Our  service  has 
tried  out  this  system  and  has  become  thoroughly  convinced 
that  the  company  mess  is  much  superior.  The  chief  reason 
for  our  decision  is  that,  when  a  command  moves  into  the 
field,  company  messes  are  imperative,  and,  therefore,  com- 
pany cooks  must  be  trained  and  mess  equipment  ready.  An 


154  MILITARY  HYGIENE 

organization  of  100  men  in  garrison  will  require  a  mess  staff 
consisting  of  one  non-commissioned  officer,  one  first  and 
one  second  cook,  one  or  two  cook's  police,  and  a  dining  room 
orderly.  Captain  Holbrook  and  Sergeant  Dunne,  in  their 
excellent  manual  "Handling  the  Straight  Army  Ration," 
epitomize  the  requisite  factors  of  a  successful  mess  as 
follows:  "Variety  in  bills  of  fare,  careful  preparation  of  food, 
palatable  seasoning,  prevention  of  waste,  and  good  dining 
room  service."  The  average  cook,  unless  carefully  taught 
and  supervised,  wastes  an  enormous  amount  of  good  food 
in  its  preparation  and  in  throwing  away  any  excess.  Cooks 
are  prone  to  fall  into  a  rut  with  respect  to  variety.  The 
man  who  habitually  serves  his  excess  of  prepared  food  in  the 
form  of  a  thin  stew  (called  "slum"  by  the  soldiers)  will 
provoke  much  discontent.  Left  overs  may  be  served  in  a 
great  diversity  of  appetizing  forms.  Meats  can  be  made 
up  into  pies,  stews,  hashes,  cold  loaf,  croquettes,  etc.  Vegeta- 
bles can  be  used  in  puddings,  soups,  salads,  hashes,  and  stews. 
Corn  and  cereals  can  be  made  into  cakes  and  fried,  while 
potatoes  may  be  utilized  in  many  ways.  The  uses  for  stale 
bread  are  many  and  varied.  If  care  is  taken  to  place  a 
minimum  of  food  upon  each  plate,  replenishing  only  when 
desired,  the  total  wastes  from  the  tables  after  a  meal  should 
not  exceed  a  half -bucketful. 

Mess  Supervision. — Company  officers  should  know  the 
principles  of  handling,  cooking,  and  serving  the  ration,  [for 
of  all  measures  in  the  military  service  promoting  content- 
ment, a  good  company  mess  is  the  greatest.  Many  militia 
and  volunteer  companies  owe  the  physical  breakdowns 


FOODS  AND  THEIR  PREPARATION  155 

which  are  so  common  in  such  organizations  to  the  lack  of 
a  trained  field  cook  and  intelligent  mess  supervision.  Per- 
haps the  most  important  lesson  to  be  learned  by  a  newly  com- 
missioned and  inexperienced  company  officer  is  the  method 
of  preparing  ration  returns  and  of  drawing  the  food  neces- 
sary for  the  subsistence  of  his  men. 

Field  and  Reserve  Rations. — Rations  for  campaign  are  of 
two  kinds,  field  and  reserve,  whose  names  suggest  their  use. 
The  former,  consisting  chiefly  of  bacon  or  canned  meat,  fresh 
or  hard  bread,  beans,  coffee,  and  sugar,  constitutes  the  main 
reliance  of  a  field  force,  but  is  supplemented  by  such  other 
food  as  it  is  possible  to  obtain.  The  reserve  ration  is  made 
up  of  bacon,  hard  bread,  coffee,  sugar,  and  salt,  and  is  to  be 
used  when  the  field  ration  is  not  obtainable  and  then  only 
upon  the  order  of  the  commander.  In  other  words,  it  is  in- 
tended for  emergency  use.  Each  man  habitually  carries  at 
least  two  reserve  rations.  The  field  trains  convey  two  field 
and  one  reserve  ration,  and  the  supply  train  has  two  more 
field  rations  for  each  man.  Thus,  unless  the  troops  cut  loose 
from  their  transport  or  the  latter  fails,  a  command  can  subsist 
for  at  least  seven  days  on  its  own  supplies.  And,  unless  the 
exertions  of  the  troops  are  unusually  severe,  two  reserve 
rations  will  maintain  the  health  and  vigor  of  the  men  for 
four  days  should  emergency  demand.  However,  this  half 
ration  should  not  be  continued  longer  than  is  absolutely 
necessary,  as  the  body  tissues  are  being  called  upon  for  their 
stores  of  reserve  food. 

The  Quartermaster  Corps  will  usually  succeed  in  furnish- 
ing food  stuffs  supplementary  to  the  field  ration.  Most 


156  MILITARY  HYGIENE 

important  of  these  is  fresh  bread,  made  by  the  division  field 
bakeries.  The  hard  bread  is  intended  for  use  only  when 
soft  bread  is  not  available.  And  even  should  the  bakeries 
fail,  a  good  field  cook  will  usually  manage  to  have  a  supply 
of  fresh  yeast  or  baking  powder  with  which  to  make  bread  or 
biscuit.  Our  hard  bread  is  a  good  issue,  though  the  pain 
de  guerre  of  the  French  is  said  to  be  its  superior  in  palata- 
bility,  digestibility,  and  keeping  qualities.  The  War  De- 
partment has  recently  adopted  a  so-called  field  bread,  which 
has  not  yet  been  tested  in  campaign.  It  is  palatable  and, 
owing  to  a  very  thick  crust,  resists  drying  for  two  or  three 
weeks. 

Fresh  and  Canned  Vegetables. — The  only  fresh  vegetables 
which  keep  well  are  potatoes  and  onions;  others,  therefore, 
must  usually  be  supplied  in  dried  or  canned  form.  Of 
canned  vegetables,  our  reliance  is  chiefly  on  tomatoes,  which 
are  much  liked  by  our  men.  In  using  canned  goods  we  must 
assure  ourselves,  by  noting  that  the  ends  of  the  containers 
are  concave,  that  no  fermentation  has  ensued.  Bulging 
of  the  ends  indicates  gases  of  decomposition. 

Cooking  in  the  Field. — This  procedure  naturally  dif- 
fers considerably  from  that  in  garrison.  In  a  permanent 
camp  it  may  be  carried  on  much  as  in  garrison,  but  with  a 
moving  command  facilities  are  more  or  less  scant.  When 
the  regimental  train  is  at  hand,  a  field  range  may  be  available 
(Fig.  20).  This  range  may  be  carried  on  a  pack  animal,  or 
its  utensils  so  transported  and  the  range  itself  left  behind. 
Failing  these,  a  simple  trench  or  fire  pit  must  serve,  with 
cooking  in  the  individual  mess  kits.  J  It  is  advisable,  when 


FOODS  AND  THEIR  PREPARATION 


157 


starting  on  a  campaign,  to  take  along  some  fresh  bread  and 
canned  goods  in  order  to  help  out  until  cooks  become  habitu- 
ated to  the  changed  conditions.  Most  armies  are  now  sup- 
plied, at  least  in  part,  with  "rolling  kitchens"  (Fig.  21), 
which,  accompanying  troops  on  the  march,  furnish  a  hot 
soup  or  stew  as  soon  as  camp  is  reached.  This  method  will 


Fig.  20. — United  States  Army  field  range:  a,  Packed  for  transportation; 
b,  set  up  ready  for  use. 


be  given  a  trial  in  our  service,  though  our  rough  roads  and 
the  fondness  of  our  men  for  variety  render  its  success 
problematic.  Soldiers  of  the  mobile  forces  should  be  in- 
dividually taught  how  to  prepare  the  field  and  reserve 
rations. 


158 


MILITARY  HYGIENE 


Concentrated  Foods. — We  read  of  concentrated  and  tab- 
loid foods  possessing  in  small  bulk  all  the  elements  neces- 
sary to  sustain  life.  This  is  fallacious;  the  only  way  to  con- 
dense a  food  is  to  drive  off  its  contained  water.  Its  more 
valuable  principles  cannot  be  extracted  by  any  known  proc- 
ess. All  so-called  emergency  rations,  therefore,  possess 
considerable  bulk  and  weight,  while  they  are  at  the  same 


Fig.  21. — Rolling  kitchen,  Austrian  model  (Dunbar,  in  Journal  Royal 
Army  Medical  Corps). 

time  deficient  in  fuel  value.  The  British  have  one  of 
chocolate  and  "plasmon,"  the  latter  being  a  milk  product. 
The  German  "iron  ration"  is  composed  of  biscuit,  preserved 
meat,  preserved  vegetables,  and  coffee,  and  weighs  1J 
pounds.  Our  army  has  experimented  largely  with  emer- 
gency rations,  but  has  not  found  a  satisfactory  one.  The 


FOODS  AND  THEIR  PREPARATION  159 

German  "erbswurst"  (pea  sausage),  made  up  of  pea  flour, 
fat  pork,  and  salt,  is  a  valuable  food  in  small  bulk.  An- 
other useful  article  of  this  class  is  "pemmican,"  a  food  of 
American  origin,  which  consists  of  dried  lean  beef,  tallow, 
currants,  and  sugar,  compressed  into  cakes. 

Arctic  and  Tropical  Rations. — In  preparing  a  ration  for 
tropical  or  arctic  service,  departures  from  the  ordinary  ration ' 
are  not  so  great  as  might  be  surmised.  Briefly,  Americans 
serving  in  the  tropics  desire  a  little  less  meat  and  fat  and 
considerably  more  sugar.  In  Alaska  an  increase  in  meats 
and  particularly  in  fats  is  craved. 

Diseases  Resulting  from  Faulty  Diet. — There  are  certain 
diseases  which  result  from  (I)  the  lack  of  proper  food  or  (II) 
the  use  of  infected  materials.  Under  the  first  head  we  have: 
(a)  Scurvy.  This  disease,  though  formerly  greatly  dreaded 
by  field  armies  and  ships'  crews,  is  now  but  rarely  encoun- 
tered. It  is  due  to  faulty  diet  and  especially  to  the  absence 
from  the  diet  of  organic  acids  existing  in  fresh  meats  and 
vegetables,  (b)  Beriberi  caused  many  deaths  and  much 
disability  among  our  Philippine  scouts  until  it  was  learned 
that,  in  the  milling  of  the  rice  which  forms  their  chief  food, 
some  necessary  substance  was  removed  with  the  hull. 
The  exact  nature  of  this  substance  has  not  yet  been  deter- 
mined, but  the  use  of  "undermilled"  rice  has  produced  a 
complete  disappearance  of  the  disease  from  that  command. 

Diseases  Due  to  Infected  Food. — Under  the  second  head 
we  find  that  such  communicable  diseases  as  typhoid  fever 
and  tuberculosis  may  be  transmitted  by  infected  milk  and 
other  raw  foods.  Imperfectly  cooked  meats — especially  of 


160  MILITARY  HYGIENE 

swine — may.  convey  tapeworms  and  trichinosis.  This  latter 
disease  is  characterized  by  the  lodgment,  in  the  muscles,  of 
a  great  number  of  small  spiral  worms.  Glanders  may  be 
contracted  by  man  through  contact  with  the  pus  from  an 
infected  animal.  The  disease  of  this  class  most  commonly 
encountered  in  our  military  service  is  ptomain-poisoning. 
Ptomains  are  chemical  compounds  resulting  from  the  decom- 
position of  organic  substances;  in  food-poisoning  they  are 
developed  most  often  in  warmed-over  hash,  canned  fish, 
and  sausage.  The  symptoms  are  violent  vomiting,  colic, 
and  diarrhea,  attended  by  great  prostration.  Often  a  large 
number  of  men  belonging  to  one  company  are  affected  at 
the  same  time.  Fortunately,  though  alarming,  ptomain- 
poisoning  is  not  usually  fatal. 


CHAPTER   X 
THE  SANITATION  OF  POSTS,  BARRACKS,  AND  TRANSPORTS 

The  Sanitation  of  Posts 

Sites. — Naturally,  the  first  matter  to  interest  us  in  this 
connection  is  the  site  of  the  post.  This  may  be  unhealth- 
ful  by  reason  of  certain  factors  neglected  in  its  selection 
or  ignored  on  account  of  military  expediency.  A  healthful 
site  depends  primarily  upon  the  character  of  the  soil,  espe- 
cially with  reference  to  the  amount  of  moisture  therein. 
Granite,  limestone,  metamorphic  and  trap  rocks,  sandstones, 
well-cultivated  soils,  deep  gravels,  and  sands  furnish  dry 
and  salubrious  sites.  Made  grounds  are  usually  objection- 
able because  of  the  contained  organic  matters.  Clays, 
alluvial  soils,  and  spots  illy  drained  make  the  atmosphere 
damp  and  favor  the  development  of  tuberculosis,  rheuma- 
tism, and  colds.  The  ground  water  should  not  rise  above 
8  or  10  feet  from  the  surface.  If  it  be  higher,  underdrain- 
age  with  open  joint  tiling  should  be  installed,  the  lines 
of  pipe  being  laid  some  10  to  20  feet  apart.  Care  must  be 
taken  that  the  slope  of  fall  shall  be  even  and  the  piping 
not  liable  to  settle  into  occasional  depressions.  Aside  from 
soils  and  soil  moisture,  slopes  having  a  northern  exposure, 
enclosed  valleys,  and  ravines  are  undesirable  sites  on  account 
of  unsatisfactory  conditions  as  to  sunlight  and  air  stagnation 
or  air  currents. 

11  161 


162 


MILITARY  HYGIENE 


Barrack  Construction. — Building  sites  in  moist  soils  should 
have  foundation  drains,  damp-proof  wall  courses  (Fig.  22), 
and  thick  concrete  cellar  floorings.  If  the  building  has  no 
cellar,  it  should  be  set  up  on  brick,  stone,  or  concrete  piers, 
that  there  may  be  free  circulation  of  air  beneath.  Other 
than  dryness,  the  necessary  conditions  to  be  met  in  the 


mmm^M? 

V>& 


Fig.  22. — Damp-proof  course  for  foundations  of  buildings  (indicated  by 
the  heavy  line). 

construction  of  a  barrack  building  are  lighting,  ventilation, 
heating,  water-supply,  and  sewerage. 

Exposure. — If  barracks  are  large,  it  is  desirable  to  face 
them  so  that  their  squad  rooms  may  receive  a  maximum  of 
light  and  air.  When  their  long  axes  are  north  and  south 
the  sun  will  flood  their  rooms  from  both  sides,  and  if  this 
arrangement  brings  them  broadside  to  the  prevailing  winds, 


SANITATION  OF  POSTS,  BARRACKS,  TRANSPORTS     163 

so  much  the  better.  For  smaller  quarters  a  southern  expo- 
sure is  most  satisfactory,  being  warmer  in  winter  and,  very 
likely,  cooler  in  summer.  Sunlight  is  a  famous  purifier, 
being  inimical  to  many  kinds  of  disease  germs. 

For  the  lighting  of  dwellings,  electricity  only  should  be 
considered,  if  available.  Failing  this,  acetylene,  ordinary 
illuminating  gas,  or  mineral  oil  may  be  employed,  in  the 
order  named  as  to  desirability.  These  latter  agents  vitiate 
the  atmosphere  by  using  up  oxygen  and  giving  off  products 
of  combustion.  If  gas  is  used,  Argand  or  Welsbach  burners 
should  be  provided. 

Ventilation. — The  ventilation  of  buildings  should  be  ar- 
ranged for  by  natural  means,  that  is,  dependent  upon  the 
movement  of  the  outer  air.  Artificial  ventilation,  accom- 
plished by  forcing  air  in  or  out  with  fans,  is  but  a  poor  sub- 
stitute for  perflation,  which  means  the  passage  of  natural 
air  currents  through  a  room.  The  essential  factors  in  effi- 
cient ventilation  are:  proper  temperature  (not  too  warm), 
dryness,  and  a  certain  amount  of  movement  of  the  air. 
A  simple  and  excellent  system  of  ventilation  may  be  in- 
stalled as  follows:  (1)  Place  transoms  over  hall  doors  of  all 
rooms.  (2)  Install  ventilator  openings  in  lower  window 
sashes  of  rooms.  (3)  Put  heating  radiators  under  windows 
so  ventilated  (Fig.  23).  (4)  Provide  good-sized  openings 
above  the  windows  or  doors  at  ends  of  halls,  with  large  radia- 
tors below  these.  (5)  Where  necessary  (as  in  toilet  rooms) 
this  system  may  be  reinforced  by  air  ducts  from  basement  to 
roof,  with  a  radiator  at  the  foot  of  each. 

Air  inlets  through  walls,  terminating  beneath  radiators, 


164  MILITARY  HYGIENE 

are  in  common  use  and  are  satisfactory  when  well  kept.  But 
they  are  liable  to  become  dust  receptacles,  and  are  often 
choked  up  with  an  old  garment  by  some  fresh-air  coward. 
The  simplest  method  of  improving  the  ventilation  of  a  room 


Fig.  23. — Ventilation  system. 

without  producing  drafts  is  to  raise  the  lower  window 
sash  a  few  inches  and  fill  the  opening  with  a  board.  Air 
then  enters  between  the  sashes  and  is  directed  upward 
toward  the  ceiling,  where  it  spreads  out  and  is  warmed  some- 


SANITATION  OF  POSTS,  BARRACKS,  TRANSPORTS     165 


VENTILATOR  > 


Fig.  24. — Ventilation  system  for  temporary  buildings  by  means  of  fresh- 
air  ducts  beneath  floors,  opening  under  stoves. 

what  before  coming  in  contact  with  the  occupants  of  the 
room.  In  temporary  structures  the  best  system  is  to  bring 
the  air  in  by  ducts  beneath  the  floor;  these  discharge  through 


166  MILITARY  HYGIENE 

a  grating  directly  under  the  stoves  by  which  (presumably) 
the  building  is  heated  (Fig.  24).  The  fresh  air  is  thus  drawn 
in  and  warmed.  Vent  outlets  are  provided  in  the  ceiling 
and  through  these  the  stovepipes  pass.  If  the  rooms  are 
heated  by  open  fires,  natural  ventilation  will  be  adequate. 
In  any  case,  perflation  should  be  practised  daily  by  opening 
the  windows  for  a  time. 

Floor  and  Air  Space. — In  connection  with  the  subject  of 
ventilation,  the  consideration  of  floor  and  cubic  space  per 
occupant  is  vital.  Experience  has  demonstrated  that  not 
less  than  60  square  feet  of  floor  space  and  600  cubic  feet  of 
air  space  per  man  in  squad  rooms  is  essential  to  preserve  the 
health  of  troops.  But  these  figures  are  really  lower  than  is 
consonant  with  safety;  medical  authorities  are  of  the  opinion 
that  the  minimum  in  floor  space  should  be  70  square  feet, 
and  in  air  space,  800  cubic  feet.  This  assumes  the  usual 
ceiling  height  of  12  feet.  The  capacity  of  each  squad  room 
should  be  estimated  on  the  basis  of  the  latter  figures,  the 
number  proper  to  each  painted  on  the  door  thereof,  and  such 
number  never  exceeded.  If  a  temporary  increase  occurs 
in  a  company,  it  is  better  to  utilize  the  halls  of  barracks 
for  additional  cots  rather  than  to  diminish  floor  and  air 
space  in  squad  rooms. 

Heating  of  buildings  is  accomplished  by  one  of  three  sys- 
tems, namely,  direct,  indirect,  and  direct-indirect.  The 
first  named  is  where  the  source  of  heat  is  in  the  room  itself 
and  not  directly  connected  with  ventilation.  Under  this 
head  are  stoves,  grates,  and  steam  or  hot-water  radiators 
without  air  inlets.  "Indirect"  is  the  term  applied  to  methods 


SANITATION  OF  POSTS,  BARRACKS,  TRANSPORTS     167 

in  which  the  air  is  heated  before  entering  the  room,  this  air 
being  used  both  for  heating  and  ventilation.  Of  such  are 
hot-air  furnaces,  and  steam-coils  over  which  air  is  passed. 
The  third  system  comprises  measures  where  the  source  of 
heat  is  in  the  room  and  the  air  supply  is  brought  in  con- 
tact with  it  there.  Hot-water  and  steam  radiators  con- 
nected with  air  inlets,  or  stoves  with  air  ducts  opening 
beneath  them,  are  examples  of  this  class.  Of  all  the  methods 
indicated,  the  low-pressure  hot- water  system  of  direct  type 
is  perhaps  the  best  for  barracks,  when  conjoined  with  the 
system  of  ventilation  recommended  above.  Room  tempera- 
ture should  not  ordinarily  exceed  70°  F. 

Plumbing. — Water-supply  in  general  is  discussed  else- 
where. A  system  of  supply  implies  means  for  the  removal 
and  disposal  of  waste  water,  that  is,  a  system  of  sewerage. 
Plumbing  should  be  as  simple,  compact,  direct,  and  plain 
as  possible.  Its  various  parts  should  be  exposed,  so  that 
they  may  be  readily  accessible  and  kept  clean.  Closets 
of  the  "siphon  jet"  type,  in  which  the  bowl  and  trap  are 
molded  in  one  piece,  are  the  best  form  (Fig.  25).  Shower- 
baths  are  preferable  to  tubs  for  barrack  use,  being  economical 
in  water  used  and  less  likely  to  transmit  skin  and  venereal 
diseases.  Every  separate  fixture  (closet  bowl,  bathtub, 
shower,  basin,  urinal,  kitchen  or  slop  sink)  should  have 
a  trap  as  near  to  it  as  possible.  A  trap  is  a  bend  or  partition 
in  a  pipe  or  other  plumbing  fixture,  so  arranged  that  the 
liquid  contents  form  a  seal  which  prevents  the  passage  of 
air,  but  permits  the  flow  of  liquids.  The  seal  of  "running" 
traps  is  easily  forced  by  the  back  pressure  of  gases,  by  siphon- 


168 


MILITARY  HYGIENE 


age,  or  by  evaporation;  non-siphonage  traps,  such  as  the 
"Sanito,"  are,  therefore,  desirable  (Fig.  26).  If  a  non- 
siphoning  trap  is  not  used,  each  fixture  must  have  a  vent 
pipe  to  protect  the  seals  of  traps  and  to  carry  off  offensive 
odors.  All  vent  pipes  pertaining  to  a  set  of  fixtures  connect 
with  a  main  vent  at  a  point  higher  than  the  fixture.  The 
main  vent  joins  the  soil-pipe  above  the  top  fixture  or  is 
carried  up  through  the  roof  separately. 


Fig.  25.— Siphon  jet  closet,  "West  Point"  model  (J.  L.  Mott  Co.). 

Soil-pipe. — Waste-pipes  draining  fixtures  should  be  of 
iron  (not  lead)  and  discharge  into  the  soil-pipe.  This  is 
an  upright  pipe  of  4-inch  extra-heavy  cast  iron,  whose  lower 
end  rests  on  a  concrete  pier  in  the  cellar  and  whose  open 
upper  extremity  is  extended  through  the  roof.  Y  branches 
at  proper  points  receive  the  waste-pipes,  and  a  bend  in  the 
cellar  effects  a  junction  with  the  branch  sewer.  It  is  desir- 


SANITATION  OF  POSTS,  BARRACKS,  TRANSPORTS     169 

able  to  test  plumbing  after  installation  and  when  there  is 
suspicion  of  defects.  This  may  be  accomplished  by  one  of 
several  methods,  of  which  the  peppermint  test  is  perhaps  the 
simplest.  In  this  test,  vents  are  closed  and  traps  filled, 
after  which  2  ounces  of  oil  of  peppermint  are  poured  into  the 
top  of  the  soil-pipe,  followed  by  two  quarts  of  hot  water. 


Fig.  26. — Non-siphoning  trap  vent,  "Sanito"  model  (J.  L.  Mott  Co.). 

The  top  of  the  soil-pipe  is  then  stopped  up,  and,  if  a  leak 
exists,  the  pungent  smell  of  the  oil  may  be  detected  near 
the  defective  fixture.  When  house  plumbing  is  in  temporary 
disuse  (as  by  reason  of  absence  of  occupants)  it  should  be 
flushed  once  a  week  to  prevent  breakage  of  seals  by  evapo- 
ration, as  well  as  the  breeding  of  mosquitoes  in  open  tanks 
and  bowls. 


170  MILITARY  HYGIENE 

Stables  must  be  kept  in  a  sanitary  state,  not  only  for  the 
sake  of  the  animals,  but  to  prevent  the  propagation  of  flies 
and  rats,  which  are  justly  regarded  as  foes  of  mankind. 
Flies  breed  by  preference  in  horse  manure,  though  they 
may  develop  in  other  decaying  animal  and  vegetable  material, 
such  as  garbage.  They  will  also  breed  in  earth  soaked  with 
horse  urine.  Stable  floors  should,  therefore,  be  of  brick  or 
concrete,  and  the  bare  ground  outside,  where  horses  stand, 
should  be  sprinkled  once  a  week  with  crude  mineral  oil, 
which  is  offensive  to  the  insects.  Manure  should  be  re- 
moved daily.  Rats  are  responsible  for  the  spread  of  the 
deadly  epidemic  disease  known  as  bubonic  plague.  These 
pests  find  conditions  favorable  for  their  continued  existence 
in  an  insanitary  stable.  Such  conditions  are:  (a)  food  and 
(b)  places  suitable  for  nesting  and  breeding.  Eliminate 
either  of  these,  and  the  animals  are  driven  away.  A  cam- 
paign against  rats  should  embrace  five  measures,  viz.,  trap- 
ping; poisoning;  shooting;  cutting  off  the  food  supply;  de- 
stroying existing  nests  and  preventing  the  formation  of  new 
ones.  Metal-lined  feed  bins  and  the  plentiful  use  of  cement 
in  their  runways  and  other  haunts  are  effective  measures. 

Police  of  Grounds. — The  police  of  the  grounds  in  and 
adjoining  the  post  is  of  great  importance  from  an  esthetic 
standpoint  as  well  as  that  of  sanitation.  Wastes  must  be 
removed  and  disposed  of.  Walks  and  roads  must  be  cleaned, 
kept  free  from  dust,  and  properly  maintained.  Weeds  and 
tall  grass  should  be  cut  because  they  furnish  hiding-places 
for  mosquitoes  and  are  evidences  of  neglect.  A  consistent 
scheme  for  the  beautification  of  the  grounds  ought  to  be 


SANITATION  OF  POSTS,  BARRACKS,  TRANSPORTS     171 

carried  out.  Privies,  earth  closets,  and  cesspools  are  abomi- 
nations and  not  to  be  tolerated  in  a  permanent  garrison. 
Dumps  should  be  inconspicuous  and  no  putrescible  materials 
permitted  thereon. 

Mosquitoes. — Collections  of  standing  water  which  may 
serve  as  breeding-places  for  mosquitoes  are  to  be  sought  for 


Fig.  27. — "Knapsack"  spray  pump  for  oiling  standing  water  (F.  E. 
Myers  &  Bro.). 

and  filled  in,  drained,  oiled,  or  screened.  Hundreds  of 
these  insects  may  develop  in  a  little  rain  water  contained  in 
an  old  tin  can,  a  broken  bottle,  the  crotch  of  a  tree,  or  a 
slight  depression  in  rock  or  clay  soil.  Cisterns,  water 
troughs,  excavations,  fire  buckets,  pans  in  chicken  yards, 


172  MILITARY  HYGIENE 

boats  on  the  riverside,  water  pitchers,  open  plumbing  traps, 
and  the  like  may  contain  myriads  of  "wigglers."  Sagging 
or  choked  rain  gutters  offer  favorable  conditions  for  their 
propagation.  Gold  fish  may  be  placed  in  ornamental  ponds 
and  fountain  basins  to  devour  larvae.  Adult  mosquitoes 
often  survive  throughout  the  winter  by  hiding  in  sheltered 
places,  such  as  cellars.  Fumigation  with  sulphur  or  pyre- 
thrum,  followed  by  sweeping  up  and  burning  the  tempo- 
rarily stupefied  insects,  will  dispose  of  these  and  materially 
lessen  next  season's  crop.  Crude  oil,  kerosene,  and  a  mix- 
ture known  as  "larvacide,"  are  efficient  for  oiling  standing 
water.  These  are  conveniently  spread  by  spraying  them 
from  a  watering  pot  or  other  sprinkling  apparatus.  As 
mosquitoes  develop  from  the  egg  in  about  ten  days,  oiling 
should  be  repeated  weekly. 

The  Sanitation  of  Barracks 

Care  of  Quarters. — The  proper  care  of  their  quarters  is 
vital  to  the  health  of  the  men.  Bunks  should  be  moved 
out  from  the  wall  for  at  least  a  foot,  that  the  spaces  behind 
them  may  be  kept  clean  and  the  heads  of  the  occupants  be 
out  of  the  stagnating  air  which  clings  to  the  walls.  Beds 
and  bedding  are  to  be  inspected  as  to  cleanliness,  the  pres- 
ence ofc  bugs,  and  the  tendency  to  secrete  dirty  clothing 
under  pillows  or  mattresses.  Bedding  should  be  aired  once 
a  week.  Cuspidors,  if  used,  must  be  cleansed  and  scalded  out 
daily.  Wall  and  trunk  lockers  should  be  clean  and  orderly. 
Soiled  clothing  must  not  be  put  in  barrack  bags  while  wet. 
Wooden  floors  should  not  be  flushed  for  cleansing  purposes; 


SANITATION  OF  POSTS,  BARRACKS,  TRANSPORTS     173 

as  little  water  as  possible  is  to  be  used,  since  very  wet  floors 
dry  slowly  and  the  liquid  carries  filth  into  the  wood  fiber. 
The  use  of  a  wood  filler,  followed  by  wax  polishing  for 
squadroom  floors,  amply  repays  the  initial  labor  by  the  im- 
proved appearance,  prevention  of  fouling,  and  ease  in 
cleansing.  Sweeping  and  dusting,  as  commonly  practised, 
raise  clouds  of  dust  particles  which  settle  elsewhere.  A, 
little  wet  sawdust  strewn  on  the  floor  is  of  value  in  pre- 
venting this.  If  waxing  is  not  practicable,  the  use  of  an 
oily  floor  dressing  such  as  the  "Standard"  may  be  considered. 
All  moldings  and  ledges  upon  which  dust  may  settle  should 
be  wiped  with  a  damp  cloth.  Vacuum  cleaning  is  excellent 
in  results  and  may  replace  other  methods.  Lavatories, 
latrines,  store-rooms,  and  basement  should  be  maintained 
in  a  neat  and  orderly  state.  Especial  attention  is  to  be 
paid  to  corners  and  crevices  where  dirt  may  collect.  Take 
care  of  the  corners  and  the  middle  of  the  floor  will  take 
care  of  itself.  In  the  police  of  sinks  no  disinfectants  are 
necessary  and  their  routine  use  is  prohibited  by  army 
regulations. 

Care  of  Plumbing. — Daily  and  thorough  scrubbing  of  the 
plumbing  fixtures  will  prevent  the  urinous  odor  noted  about 
a  dirty  closet.  This  odor  is  due  to  the  deposition,  on  the 
surface  of  the  urinal  or  closet  bowl,  of  ammoniacal  salts. 
These  will  not  form  if  an  old  broom  or  a  brush  is  used  fre- 
quently and  vigorously.  The  men  should  be  protected 
from  mosquitoes  by  screens  for  windows  and  bars  for  beds. 
Spaces  under  non-cellared  buildings  and  under  porches  are 
apt  to  be  dirty  and  crowded  with  junk.  Immediate  repairs 


174  MILITARY  HYGIENE 

should  be  made  by  the  company  artificer,  of  all  defects  which 
he  is  competent  to  correct. 

Messing. — Foods  and  their  preparation  are  discussed  in 
a  separate  chapter,  but  there  are  other  matters  relating  to 
the  messing  of  troops  in  barracks  which  deserve  special  men- 
tion here.  First  and  foremost  of  these  matters  is  the  scrup- 
ulous cleanliness  of  everything  connected  with  the  mess. 
Cooks  should  be  required  to  be  clean  and  neat  in  person  and 
clothing.  They  should  have  a  daily  bath  and  should  wear 
white  clothing,  the  latter  to  be  furnished  from  the  company 
fund.  Bake  pans,  boilers,  kettles,  griddles,  and  lesser  uten- 
sils must  be  kept  scoured  within  and  free  from  soot  and 
grease  without.  When  not  in  use  these  articles  should  be 
in  a  designated  place — preferably  suspended  from  a  rack — 
where  they  are  out  of  the  way  and  may  be  inspected  readily. 
The  range  is  to  be  kept  polished  or  greased  as  to  surface,  its 
ovens  clean  and  free  from  dust  and  charred  fragments  of 
food.  The  pantry,  table  drawers,  and  shelves  require  espe- 
cial attention  to  keep  them  free  from  vermin  and  from  stock- 
ing up  with  trash  of  all  kinds.  The  tables  in  kitchen  and 
dining  room  are  to  be  scrubbed  with  hot  water  and  soap 
after  each  meal.  Refrigerators  need  much  care  to  pre- 
serve them  sweet  and  clean.  Their  waste-pipes  must  not 
be  allowed  to  discharge  on  the  ground,  thus  fouling  the 
earth  and  forming  a  pool  for  mosquito  breeding.  Dish 
cloths  must  be  thoroughly  scalded  out  after  use  and  hung 
up  to  dry. 

Fly  Destruction. — Flies  are  to  be  treated  as  enemies,  and 
constant  efforts  made  to  exclude  and  to  destrov  them. 


,  SANITATION  OF  POSTS,  BARRACKS,  TRANSPORTS     175 

Doors  and  windows  of  kitchen  and  dining  room  must  be 
efficiently  screened.  The  following  measures  are  useful  as 
destructive  agents:  (1)  Sticky  fly  paper;  (2)  saucers  contain- 
ing 1  per  cent,  formalin  with  a  little  sugar;  (3)  arsenic  paper 
in  water  (bought  in  the  shops  and  very  effective);  (4)  fly 
traps,  which  should  be  freshly  baited  every  day  (Fig.  28); 
(5)  Persian  insect  powder  (pyrethrum),  the  burning  of  which 


Fig.  28. — Fly  trap,  as  made  by  company  artificer. 

produces  fumes  which  stupefy  the  insects;  these  fall  to 
the  floor  and  may  be  swept  up  and  burned  before  they 
revive. 

Roaches. — Another  type  of  kitchen  pest  is  the  roach 
family,  of  which  the  so-called  Croton  bug  is  the  commonest 
variety.  In  fluorid  of  sodium,  a  cheap  white  powder  innocu- 
ous to  man,  we  fortunately  possess  an  agent  which  is  deadly 
to  this  insect. 


176  MILITARY  HYGIENE 

Mess  Supervision. — Cooks  should  be  familiar  with  the 
official  publications  "Handling  the  Straight  Army  Ration" 
and  "Manual  for  Army  Cooks."  Everyone  not  on  duty 
there  is  to  be  excluded  from  the  kitchen.  The  men  are  re- 
quired to  wash  their  hands  before  meals  and  to  wear  proper 
uniform  at  table.  Daily  inspections  covering  the  quality 
of  food  stuffs,  their  variety  and  their  modes  of  preparation, 
as  well  as  all  other  details  under  this  head,  are  necessary 
for  the  maintenance  of  satisfactory  conditions. 

Bakery. — The  post  bakery  requires  careful  supervision. 
Because  of  the  nature  of  their  work,  bakers  should  have  a 
daily  bath  and  make  a  complete  change  of  underclothing. 
They  should  be  provided  with  an  ample  number  of  white 
aprons  and  caps,  the  same  to  be  furnished  and  laundered 
from  the  bakery  fund.  Building,  grounds,  equipment,  and 
utensils  must  be  kept  scrupulously  clean.  War  is  to  be 
made  against  rats,  mice,  and  roaches.  Flour  is  to  be  kept 
in  a  cool,  dry,  well-ventilated  room,  remote  from  decaying 
vegetables,  kerosene,  and  other  strong-smelling  substances, 
whose  odors  it  readily  absorbs.  All  flour  should  be  sifted 
before  using  to  remove  foreign  substances,  such  as  weevils 
and  mouse  droppings.  Sourness  in  bread  is  often  due  to 
the  lodgment,  along  cracks  in  wooden  mixing  troughs,  of 
particles  of  old  dough.  Bread  should  not  be  issued  before 
it  is  twenty-four  hours  old.  During  issue  to  and  transporta- 
tion by  organizations,  it  should  be  kept  covered  and  not 
handled  with  dirty  fingers. 

Guard-house. — At  the  average  post  insanitary  conditions 
are  found  at  the  guard-house  more  often  than  in  any  other 


SANITATION  OF  POSTS,  BARRACKS,  TRANSPORTS     177 

building.  These  are  usually:  overcrowding;  insufficient 
ventilation;  lack  of  proper  cleanliness;  overheating;  presence 
of  bedbugs.  Such  defects  result  largely  from  divided  re- 
sponsibility, a  new  guard  being  mounted  every  twenty- 
four  hours.  To  prevent  infestation  by  bugs,  walls  and 
floors  should  be  of  impervious  material.  Where  the  insects 
have  effected  a  lodgment,  live  steam  from  a  portable  boiler; 
turned  into  the  closed  room,  is  more  effective  than  any  other 
agent,  since  it  destroys  the  eggs  as  well  as  the  bugs.  A 
guard-house  should  have  its  own  water-closets  and  shower- 
baths,  which  require  careful  supervision. 

Inspections. — Finally,  the  system  of  inspection  should  be 
thorough  and  complete.  It  is  not  necessary  to  cover  daily 
every  point  discussed  in  this  chapter,  but  visits  should  be 
sufficiently  frequent,  irregular  and  unheralded,  to  keep  those 
directly  concerned  upon  the  alert. 

The  Sanitation  of  Transports 

The  Transport. — The  troopship,  which  is  known  in  our 
service  as  a  transport,  is  a  vessel  used  for  the  conveyance  of 
soldiers  by  water.  As  the  ship  is  a  floating  habitation,  its 
sanitation  is  considered  here.  A  transport  ought  to  be 
suited  to  and  fitted  up  for  its  special  purpose,  but,  as  war 
may  come  suddenly,  vessels  illy  adapted  for  such  use  may 
have  to  be  utilized,  as  was  the  case  in  1898.  Roughly 
considered,  the  capacity  of  a  ship  may  be  computed  at  the 
rate  of  2|  tons  net  per  man,  or  7  tons  per  animal.  To  reduce 
gross  tonnage  to  net,  multiply  by  .65. 

Ventilation. — The  most  important  problem  relating  to 
12 


178  MILITARY  HYGIENE 

the  sanitation  of  a  transport  is  the  ventilation  thereof. 
Troops  are  so  crowded  on  the  berth  decks  (sleeping  quarters) 
that  the  bunks  are  in  two  tiers  and  the  individual  soldier 
has  but  20  square  feet  of  floor  space  and  200  cubic  feet  of 
air  space.  Such  conditions  are  favorable  to  the  trans- 
mission of  communicable  diseases.  Air  must,  therefore, 
be  changed  much  more  frequently  than  in  barracks  and  an 
artificial  system  of  ventilation  is  a  necessity.  In  the  opera- 
tion of  such  a  system,  the  chief  difficulty  lies  in  the  avoid- 
ance of  drafts,  which  produce  discomfort  and  may  cause 
sickness.  Berth  decks  are  best  supplied  with  fresh  air  by 
forcing  it  in  from  without  by  motor-driven  fans.  In  cold 
weather  the  incoming  air  should  be  warmed.  Where  objec- 
tionable odors  or  excess  heat  are  present  (as  in  latrines, 
kitchens,  and  boiler  rooms),  an  evacuating  system  is  in- 
stalled separately  in  addition  to  the  other.  Aids  to  natural 
ventilation,  such  as  windsails,  louvers,  and  open  ports,  should 
supplement  the  artificial  methods.  To  avoid  atmospheric 
vitiation,  smoking  is  prohibited  on  berth  decks,  and,  to 
enable  the  air  to  be  completely  changed  and  freshened,  these 
decks  are  vacated  (weather  permitting)  from  8  A.  M.  until 
after  morning  inspection. 

Messing. — A  mess  officer,  detailed  from  the  troops,  is 
assigned  to  see  that  the  men  are  properly  fed  and  to  super- 
vise all  matters  relating  to  kitchen  (galley)  management. 
No  food  is  allowed  in  the  men's  sleeping  quarters.  A 
cold-storage  compartment,  a  butcher  shop,  and  a  bakery 
are  necessary  parts  of  the  messing  equipment  of  a  trans- 
port. 


SANITATION  OF  POSTS,  BARRACKS,  TRANSPORTS     179 

Sanitary  Rules. — On  boarding  a  transport,  the  men  should 
be  instructed  concerning  the  location,  use,  and  sanitation  of 
water-closets,  urinals,  shower-baths,  lavatory  bowls,  laundry 
tubs,  and  drinking-water  supply.  Sanitary  rules  should  be 
printed  and  posted  conspicuously. 

Water-supply. — Drinking-water  containers  should  have 
"bubbling"  taps;  if  these  are  not  available,  the  common  cup* 
is  to  be  kept  in  a  weak  antiseptic  solution.  As  the  supply 
of  fresh  water  (which  is  ordinarily  derived  from  a  distilling 
apparatus)  is  not  sufficient  for  all  purposes,  sea  water  must 
be  used  for  baths  and  laundry  tubs,  but  as  clothing  washed 
with  sea  water  does  not  dry  readily,  garments  should  be 
rinsed  with  fresh  water  after  laundering.  Water  tanks  are 
covered  or  screened  to  prevent  mosquito  propagation. 

General  Police. — Since  the  men  are  so  closely  aggregated, 
cleanliness  of  their  persons,  of  their  clothing,  and  of  the 
ship  itself  is  of  great  importance.  Much  seasickness  is  to 
be  anticipated  early  in  the  voyage  and  during  heavy  weather, 
so  special  arrangements  must  be  made  at  such  times  to  cope 
with  this  condition.  Large  details  of  men  not  so  affected 
should  be  made  to  care  for  the  sick  and  to  maintain  clean- 
liness. If  this  is  not  done  the  berth  decks  are  soon  rendered 
virtually  uninhabitable.  A  police  officer  and  a  police  ser- 
geant are  designated  to  maintain  order  and  cleanliness  in 
all  parts  of  the  ship  occupied  by  troops.  A  non-commis- 
sioned officer  is  assigned  in  charge  of  each  wash-room,  water- 
closet,  and  the  like,  and  enough  privates  are  detailed  to  keep 
these  clean.  Rifles  are  kept  in  racks;  packs,  in  designated 
places.  Sentinels  are  posted  at  all  important  points  to  see 


180  MILITARY  HYGIENE 

that  orders  are  carried  out,  that  gangways  are  kept  clear, 
and  that  no  disturbances  arise.  Sweepings,  remnants  of 
food,  etc.,  must  not  be  thrown  from  ports.  Bedding  is  to 
be  aired  on  deck  every  clear  day.  Bedbugs  are  frequently 
found  on  shipboard.  They  must  be  carefully  searched  for 
and  destroyed.  Scrubbing  or  spraying  crevices  in  bunks 
with  kerosene  or  a  carbolized  solution  will  destroy  the  insects; 
boiling  water  will  dispose  of  eggs  as  well  as  of  bugs.  As 
the  tendency  to  dampness  is  so  great,  this  should  not  be  en- 
hanced by  flushing  floors  of  berth  decks;  these  are  to  be 
cleansed  with  a  minimum  of  water,  soiled  areas  being  wiped 
up  rather  than  scrubbed.  Spitting  on  floors  is  prohibited. 
Unusual  odors  are  traced  to  their  source  with  a  view  to 
their  abatement.  A  careful  inspection  is  made  daily  at 
10  A.  M.  by  the  commanding  officer  of  troops,  the  police 
officer,  and  the  surgeon. 

Personal  hygiene  is  insisted  upon.  Vigorous  exercise  is 
taken,  by  drills  or  calisthenics,  for  at  least  twenty  minutes 
each  day.  Bathing  is  enforced  and  facilities  given  for 
laundering  of  clothing.  Men  are  encouraged  to  keep  in  the 
open  air  as  much  as  possible.  A  weekly  examination  of 
enlisted  men,  in  their  underwear,  is  held  to  determine  clean- 
liness as  well  as  to  detect  cases  of  disease,  such  as  venereal 
affections,  lice,  and  the  itch.  Drinking  and  gambling  are 
prohibited,  while  athletic  contests  and  various  amusements 
are  encouraged. 


CHAPTER  XI 

THE   HYGIENE   AND   SANITATION    OF  MARCHES,  CAMPS, 
AND  BATTLEFIELDS 

Marches 

Principles. — To  quote  from  the  Field  Service  Regulations, 
"Good  marching  is  secured  by  careful  preparation,  strict 
discipline,  and  the  due  observance  of  march  sanitation." 
The  attainment  of  the  last-named  requirement  is  dependent 
in  great  part  upon  the  other  two,  for  ill-trained  and  poorly 
disciplined  troops  violate  all  the  laws  of  health. 

Preparation. — Sanitation  on  the  march  implies  a  watchful 
attention  to  all  conditions  which  relate  to  the  care  of  troops. 
The  "careful  preparation"  of  the  Regulations  includes  the 
training  of  soldiers,  in  advance  of  a  campaign,  in  hygienic 
and  sanitary  principles  and  observances.  The  sick  must  be 
left  behind,  and  such  weak  individuals  as  may  be  discovered 
by  preliminary  observation  eliminated.  Venereal  diseases 
and  foot  abnormalities  are  especially  conducive  to  early 
breakdown.  Protection  against  special  diseases,  notably 
typhoid  fever  and  small-pox,  must  be  provided  by  vacci- 
nations. Troops  should  be  trained  in  marching.  Short 
marches  gradually  extended,  first  without,  then  with,  field 
equipments,  are  necessary  to  harden  the  muscles,  to  toughen 
the  feet,  and  to  inure  the  men  to  minor  discomforts  which  at 
first  seem  real  hardships.  After  a  seasoning  of  ten  to  four- 

181 


182  MILITARY  HYGIENE 

teen  days,  good  infantry  can  march  indefinitely  and  wear 
down  the  animals  of  the  mounted  branches.  In  such  train- 
ing men  should  be  instructed  to  walk  with  their  toes  directed 
forward,  so  that  the  weight  is  borne  by  the  line  of  greatest 
strength  of  the  foot.  Men  with  weak  arches  invariably  toe 
out.  The  flexion  step  of  the  French  (in  which  the  knees  and 
hips  are  slightly  bent,  the  body  inclined  forward,  the  feet 
raised  very  little  and  planted  flat)  is  worthy  of  our  serious 
study.  Anyone  who  has  seen  this  method  of  progression  is 
sure  to  be  impressed  by  its  results  on  the  rate  and  length 
of  the  march,  as  well  as  by  the  good  condition  of  the  troops 
at  the  end  thereof. 

March  Order. — In  order  that  subordinates  may  know  the 
hour  for  the  start,  their  place  in  column,  etc.,  the  com- 
mander issues  a  march  order,  which  is  usually  published  the 
evening  before.  The  start  is  made  early,  but  not  so  early 
that  the  men  are  turned  out  before  daybreak.  Nor  should 
they  be  required  to  don  their  equipment  nor  to  get  into 
column  before  the  time  set.  As  marching  at  the  tail  of  a 
column  is  more  fatiguing  than  at  the  head,  it  is  customary  to 
rotate  organizations  in  these  situations  on  successive  days. 
Thus,  each  company  of  a  battalion,  each  battalion  of  a 
regiment,  each  regiment  of  a  brigade,  and  each  brigade  of  a 
division  takes  its  place  in  turn.  Route  step  is  habitually 
employed,  except  perhaps  in  passing  through  towns.  Halts 
are  made  at  intervals,  to  rest  the  men  and  animals  and  to 
enable  the  former  to  attend  to  the  calls  of  nature. 

Halts. — The  first  halt  is  usually  of  fifteen  minutes'  dura- 
tion and  is  made  when  the  column  has  been  on  the  road  for 


SANITATION  OF  MARCHES,  CAMPS,  BATTLEFIELDS     183 

one-half  or  three-quarters  of  an  hour.  The  place  should  be 
selected  with  a  view  to  reasonable  privacy,  and  spots  are 
designated  where  the  men  of  each  company  (or  battalion) 
may  void  their  excrement.  A  police  party  from  each  of 
these  organizations  is  detailed  to  dig  a  few  individual  shallow 
trenches,  which  are  covered  in  before  the  command  moves 
on.  Indiscriminate  fouling  of  the  ground  is  thus  avoided 
and  the  interests  of  the  inhabitants  and  of  following  organi- 
zations are  protected.  Subsequent  halts  of  ten  minutes' 
duration  are  ordinarily  made  at  hourly  intervals.  At  such 
times  the  men  are  allowed  to  fall  out  of  ranks  and  are  encour- 
aged to  remove  their  packs  and  to  rest  upon  the  ground, 
preferably  at  full  length. 

Factors  Affecting  March. — The  length  of  the  march  is 
largely  governed  by  the  size  of  the  command.  Other 
factors  are  the  character  of  troops,  their  seasoning  and 
discipline,  the  kind  of  road  (dusty,  muddy,  sandy,  snowy), 
the  weather  conditions  (rain,  heavy  wind,  etc,).  It  is  im- 
portant to  remember  that  though  the  head  of  the  column  may 
have  a  good  road,  the  rear  is  probably  marching  through 
mud  or  dust.  And  if  the  men  at  the  head  of  a  long  column 
are  allowed  to  pick  their  way  around  puddles,  etc.,  such 
column  will  soon  be  much  extended,  causing  many  irritating 
stops  and  hurried  efforts  to  close  up  to  proper  distances. 
It  is  very  fatiguing  to  support  the  heavy  pack  while  at  a 
standstill,  uncertainly  awaiting  a  resumption  of  the  forward 
movement.  There  is  a  tendency  to  lag  in  the  later  stages 
of  a  march.  At  such  times  the  slowing  results  from  a  short- 
ening of  the  step  rather  than  from  a  less  number  of  steps 


184  MILITARY  HYGIENE 

per  minute.  Where  possible  and  desirable  the  men  may  be 
relieved  of  a  part  of  their  packs,  but  it  is  usually  inadvisable 
to  separate  the  soldier  from  any  part  of  his  equipment. 
If  the  men  become  dependent  upon  aid  for  its  carriage  they 
will  abandon  a  part  of  their  load,  or  break  down,  or  grow 
discontented,  when  transport  is  not  available.  The  com- 
mander plans  to  have  a  march  end  early  enough  to  enable 
the  wagons  to  come  up,  so  that  the  men  may  make  camp 
before  dark.  In  hot  weather  the  march  is  usually  conducted 
in  the  cooler  part  of  the  day.  If  a  forced  march  is  necessary, 
there  must  be  adequate  halts  for  rest  and  food.  Probably 
two  periods  a  day,  of  three  or  four  hours  each,  will  be  found 
essential  for  this  purpose.  Night  marching  is  only  to  be 
required  for  tactical  reasons,  since  loss  of  sleep  and  nervous 
strain  are  apt  to  induce  a  large  percentage  of  physical 
breakdowns. 

Marching  Aids. — Singing,  the  playing  of  music  in  march 
time  by  regimental  bands,  and  good-natured  chaffing  among 
the  men  help  to  keep  up  the  spirits.  It  is  often  practicable 
to  make  up  a  lunch  sandwich  from  the  food  served  at  break- 
fast. On  the  march  it  is  desirable  to  breathe  only  through 
the  nose,  in  order  not  to  draw  dust  into  the  lungs.  Some 
relief  from  heat  rays  is  afforded  by  carrying  a  wet  handker- 
chief or  some  green  leaves  in  the  hat.  Avoidance  of  rapid 
chilling,  if  wet  or  overheated,  is  imperative. 

Thirst  and  Beverages. — Since  the  diseases  which  cause  the 
greatest  amount  of  sickness  in  campaign  proceed  largely 
from  drinking  impure  water,  the  best  course  is  to  regard  all 
water  (except  such  as  has  been  examined  and  approved  by 


SANITATION  OF  MARCHES,  CAMPS,  BATTLEFIELDS     185 

a  medical  officer)  as  unsafe  until  it  has  been  boiled  or  other- 
wise purified.  Canteens  should  be  carried  filled.  Recruits 
are  prone  to  empty  their  canteens  between  halts,  refilling 
and  redrinking  at  every  opportunity.  As  a  result,  they  per- 
spire excessively  and  tire  out  more  easily,  while  they  suffer 
much  if  the  supply  is  cut  down.  Old  soldiers  learn  to  drink 
heartily  before  the  start  and  sparingly  on  the  march.  A 
certain  amount  of  water  is,  of  course,  needed  to  replace  that 
lost  from  the  blood  by  perspiration,  but  mere  dryness  of 
the  throat  is  apt  to  be  mistaken  for  thirst.  This  feeling  is 
relieved  by  carrying  a  leaden  bullet  or  small  pebble  in  the 
mouth,  which  acts  by  increasing  the  flow  of  saliva.  Weak, 
unsweetened  coffee  may  often  be  had  from  the  excess  in  the 
company  pot;  it  appears  to  quench  thirst  better  than  plain 
water  and  is  an  excellent  beverage  with  which  to  fill  the  can- 
teen, as  it  has  been  sterilized  by  boiling. 

The  care  of  the  feet  of  the  marching  soldier  is  dwelt  upon 
elsewhere,  but  the  importance  of  the  subject  cannot  be  too 
much  emphasized.  The  preliminary  toughening  of  the  skin, 
the  use  of  foot  powder  or  soap  in  the  socks,  the  application 
of  adhesive  plaster  to  threatened  areas,  daily  cleansing,  and 
the  prompt  report  of  actual  lesions  to  a  medical  officer, 
constitute  the  essentials. 

Days  of  Rest. — A  rest  every  Sunday  and  at  such  other 
times  as  required  for  recuperation,  repairs  of  kits,  etc.,  helps 
to  keep  the  command  fit.  A  marching  command  is  a  healthy 
one,  but  only  when  reasonable  care  is  taken  to  so  maintain  it. 

Sickness. — The  regulations  require  that  no  man  shall 
leave  the  ranks  without  permission.  If  a  soldier  wishes  to 


186  MILITARY  HYGIENE 

fall  out  on  account  of  sickness,  he  must  ask  permission  of 
his  company  commander.  If  this  officer  thinks  the  case  a 
proper  one,  he  gives  a  written  permit,  and  the  man  (accom- 
panied by  a  non-commissioned  officer,  if  thought  desirable) 
waits  by  the  roadside  till  the  first  medical  officer  comes  up. 
This  officer  examines  him  and  either  directs  him  to  rejoin 
his  company  or  gives  him  a  diagnosis  tag  authorizing  him 
to  be  taken  on  or  to  accompany  the  regimental  ambulance. 
His  permit  is  endorsed  with  the  action  taken  and  is  returned 
to  the  company  commander  at  the  next  halt.  Should  the 
company  commander  think  best,  he  may  have  the  man 
relieved  of  a  part  or  all  of  his  pack  and  direct  him  to  con- 
tinue the  march  thus  unencumbered. 

Railroad  Journeys. — In  the  movement  of  troops  by  rail, 
due  provision  must  be  made  for  their  accommodations; 
water  and  ice  supply;  messing  facilities;  closets  and  toilet 
paper;  measures  for  cleanliness;  lighting  and  heating;  police 
of  cars,  and  disposal  of  refuse.  Inspections  should  be  made 
frequently  with  reference  to  the  sanitary  conditions.  As  the 
officers  usually  travel  on  a  car  separate  from  their  organi- 
zations, the  duty  of  enforcing  order,  cleanliness,  and  decency 
falls  to  the  senior  non-commissioned  officer  in  each  car. 
Men  are  apt  to  be  very  careless  at  such  times,  and  must  be 
prevented  from  spitting  on  floors,  defacing  cars,  gambling, 
and  acting  in  an  unseemly  manner.  Food  is  prepared  either 
by  a  kitchen  car  for  the  entire  train  or  by  a  special  heater 
for  each  car.  The  latter  may  be. operated  by  the  gas  sup- 
plied for  car  lighting  and  is  thought  to  be  the  better  plan, 
as  meals  are  furnished  more  promptly  and  with  far  less  con- 


SANITATION  OF  MARCHES,  CAMPS,   BATTLEFIELDS     187 

fusion.     Mess  kits  must  be  cleansed  and  inspected  after 
each  meal. 

Camps 

Types  of  Camps. — There  are  different  types  of  military 
camps,  having  respect  to  length  of  occupation  and  kinds  of 
shelter.  Sanitation  in  each  varies  with  the  conditions  en- 
countered, but  certain  principles  are  common  to  all.  Types 
of  camp  which  are  uncommon  to  our  service  will  merely  be 


Fig.  29. — Pyramidal  tent,  with  tripod  support  (United  States  Army 
standard  model  for  fixed  camps). 

cited.  Thus  a  bivouac,  which  is  a  camp  without  shelter, 
does  very  well  for  short  periods  in  fine  weather,  but  is  con- 
ducive to  physical  inefficiency  when  the  season  is  inclement. 
Cantonments,  -in  which  the  troops  are  sheltered  in  huts  or 
other  temporary  buildings,  are  exceptional,  and  billeting  is 
still  more  so.  Our  troops  are  ordinarily  sheltered  under 
canvas,  and  camps  having  this  provision  are  referred  to  as 
temporary  or  fixed  in  accordance  with  their  duration.  Other 
names  used  for  the  latter  are:  camps  of  position;  canton- 


188  MILITARY  HYGIENE 

ment  camps;  standing  camps.  Camps  occupied  by  a  march- 
ing command  are  temporary;  those  used  for  maneuver  and 
mobilization  purposes  belong  to  the  latter  class. 

The  risk  of  disease  increases  with  length  of  occupation  of 
a  camp  site,  owing  chiefly  to  fouling  of  the  ground  or  of  the 
water-supply.  Where  the  site  is  occupied  for  but  a  single 
night,  our  sanitary  arrangements  are  less  elaborate  and  many 
of  our  procedures  simpler.  For  this  reason  the  following 
discussion  will  apply — where  not  otherwise  specified — more 
particularly  to  fixed  camps. 

Camp  Sites. — Areas  intended  for  camping  should  be  se- 
lected with  care.  The  requirements  of  a  good  camp  site 
are  high,  dry  ground,  with  availability  of  wood  for  fires, 
of  water  for  general  purposes,  and  of  grass  for  horse  feed. 
Military  necessity  may  force  the  utilization  of  an  unhealthy 
site,  but  the  commander  must  be  prepared  for  probable 
physical  detriment  to  men  or  animals  resulting  therefrom. 
Sites  previously  occupied  within  the  year  should  be  avoided 
because  of  the  risk  of  infection.  Our  regulations  require 
that  the  area  shall  be  inspected,  previous  to  its  occupancy, 
by  officers  designated  for  the  purpose.  Such  inspection 
should  include  an  inquiry  as  to  the  presence  of  contaminated 
wells,  springs,  and  creeks;  probably  infected  privies;  recent 
cases  of  communicable  diseases  among  the  inhabitants; 
habits  as  to  the  disposal  of  wastes  in  the  vicinity;  manure 
piles  and  mosquito-breeding  areas  on  and  near  the  camp 
site;  dirty  dairies;  any  other  matters  which  may  relate  to 
disease  prevention.  Sites  for  fixed  camps  should  be  pre- 
pared in  advance  by  clearing,  grading,  draining,  and  the 


SANITATION  OF  MARCHES,  CAMPS,  BATTLEFIELDS    '189 

installation  of  general  sanitary  appliances.  Care  must  be 
taken  to  prevent  fouling  of  the  soil  by  workmen  and  to  avoid 
cutting  it  into  dust  or  mire  by  vehicles.  The  Quartermaster 
Corps  should  have  the  necessary  equipment  and  supplies 
on  hand  in  ample  time.  These  may  include  any  or  all  of 
the  following  articles,  viz.,  excavator  wagons;  garbage  carts; 
water-carts;  galvanized  iron  water-tanks;  incinerators,; 
garbage  and  urinal  cans;  water-cans  with  faucets;  wire 
and  gauze  netting  for  food  covers;  straw  for  bedsacks; 
stoves  or  spiders  for  laundry  fires;  clothes  boilers;  fuel; 
crude  oil;  lime;  lumber;  extra  valves  for  pumps.  Civilian 
scavengers  should  be  on  hand  and  instructed  in  their  duties. 
The  first  day  or  two  should  be  devoted  to  settling  the  troops 
comfortably  in  camp  and  making  the  sanitary  arrangements 
of  the  separate  organizations.  On  arrival,  the  camp  com- 
mander issues  an  order  giving  detailed  instructions  as  to 
matters  of  general  import,  including  sanitation. 

Halt  Order. — The  commander  of  a  marching  column  issues 
a  "halt  order,"  in  persuance  of  which  certain  staff  officers 
precede  the  command  by  several  hours.  They  select  the 
camp  site  and  designate  places  for  obtaining  drinking  and 
cooking  water,  for  watering  animals,  for  bathing  and  laundry 
purposes,  in  the  order  named,  from  up  stream  down.  Upon 
the  arrival  of  the  troops,  guards  are  immediately  set  at  these 
places  to  insure  their  proper  use.  As  the  various  organiza- 
tions reach  camp,  each  commander  at  once  details  a  party 
to  dig  a  small  sink  till  time  permits  more  permanent  arrange- 
ments. If  picks  and  shovels  are  not  available,  a  retired  spot 
is  selected  where  the  men  may  relieve  themselves,  and  a 


190  MILITARY  HYGIENE 

guard  is  placed  there.  These  measures  obviate  the  danger- 
ous and  disgusting  fouling  of  the  camp  site  by  feces  and  urine. 

Disposal  of  Wastes. — The  most  essential  feature  of  camp 
sanitation  is  the  efficient  disposal  of  wastes.  If  it  is  neces- 
sary to  remove  refuse  substances  in  civil  communities,  it 
is  even  more  so  where  a  multitude  of  men  are  closely  aggre- 
gated within  the  cramped  limits  of  a  camp.  Of  such  wastes, 
the  discharges  from  the  bodies  of  the  men  themselves  are 
most  important,  since  they  are  offensive  to  sight  and  smell 
and  are  likely  to  contain  and  Jo  convey  the  germs  of  the  most 
serious  of  the  camp  diseases.  But  other  refuse  matter, 
such  as  kitchen  wastes — wet  and  dry — horse  manure,  camp 
sweepings,  and  rubbish  of  all  kinds,  tends  to  accumulate  and 
must  be  removed.  Provision  must  also  be  made  for  the 
adequate  disposal  of  fouled  water  from  basins,  baths,  and 
laundry  places,  as  well  as  of  excess  flow  from  taps  and  of 
storm  waters. 

Disposal  of  Excreta. — Where  camps  are  located  near  posts 
or  cities,  it  may  be  possible  to  use  water-closets  connected 
with  an  existing  sewer  system,  for  the  disposal  of  excreta  and 
liquid  wastes.  Our  service  has,  since  the  war  with  Spain, 
made  extended  trials  of  two  methods  of  treatment  of  body 
discharges.  One  is  their  complete  destruction  by  fire  (which 
is  the  greatest  of  all  cleansers)  in  one  or  other  of  the  incin- 
erators described  in  the  chapter  on  "The  Disposal  of  Wastes." 
Prompt  and  thorough  incineration  is  the  ideal  treatment, 
but  in  practice  certain  impediments  have  been  experienced, 
of  which  the  principal  are:  (a)  It  has  been  found  difficult 
to  hire  scavengers  willing  and  competent  enough  to  care 


SANITATION  OF  MARCHES,  CAMPS,  BATTLEFIELDS     191 

for  the  incinerators  properly;  (b)  when  not  well  tended,  foul 
odors  are  developed,  to  the  general  discomfort;  (c)  these 
devices  are  expensive  in  cost  and  upkeep.  The  other 
method  is  that  known  as  the  Reed  trough  or  "odorless  exca- 
vator" system.  In  this  system  the  excreta  are  received  in  a 
long  trough  partly  filled  with  water,  from  which  the  contents 
are  transferred  daily  to  a  tank  wagon  by  means  of  a  handr 


Fig.  30. — "Odorless  excavator"  tank  wagon,  with  pump  as  a  trailer. 

pump  (Figs.  30,  31).  Although  lime  is  sometimes  recom- 
mended for  use  in  the  troughs  as  a  deodorant  and  fly  deter- 
rent, it  is  not  to  be  compared  in  value  for  this  purpose  with 
crude  oil.  The  only  disadvantage  of  the  oil  is  that  it  rots 
the  rubber  valve  of  the  pump.  Defects  in  this  method  are: 
(a)  Frequent  breaking  down  of  pump ;  (6)  fouling  the  ground 
by  leakage;  (c)  difficulty  in  final  disposition  of  the  material. 


192 


MILITARY  HYGIENE 


These  methods,  when  well  managed,  are  excellent  in  theil 
results,  but,  though  suitable  for  fixed  camps,  they  are 
not  practicable  for  troops  on  the  march.  Since  temporary 
camps  are  those  normal  to  campaign,  and  as  soldiers  must 
learn  to  care  for  themselves  in  the  field,  our  sanitarians  have 
reverted  to  the  use  of  a  pit  in  the  ground  as  the  only  prac- 
ticable means  of  disposal  so  far  devised  for  the  excreta  of 


Fig.  31. — Hand-pump  for  use  with  "odorless  excavator"  apparatus. 

marching  commands.  Pits  for  this  purpose  are  usually 
designated  as  sinks  or  latrines  and  are  of  two  kinds — the 
short,  shallow  individual  type  intended  for  very  brief  periods, 
and  the  larger,  deeper  company  ones.  These  must  be 
placed  on  the  flank  opposite  the  kitchens  to  minimize  the 
danger  from  flies.  They  should  be  screened  for  privacy, 
lantern  lighted  by  night,  and  have  an  orderly  to  maintain 
them  in  a  cleanly  state.  The  fecal  deposits  of  a  marching 


SANITATION  OF  MARCHES,  CAMPS,  BATTLEFIELDS     193 

command  are  immediately  covered  with  earth.  Deep  pits 
used  in  a  fixed  camp  are  (except  in  winter)  made  fly-proof 
by  boards  or  sacking  over  the  top  and  have  seats  with  self- 
closing  covers.  Urinal  cans,  marked  by  lanterns,  are 
placed  in  the  company  streets  at  night.  One  of  the  most 
decided  evidences  of  a  poorly  disciplined  command  is  the 
presence,  around  the  edges  of  a  camp,  of  fecal  deposits. 
Men  urinating  or  defecating  upon  the  ground  within  or 
close  to  the  camp  limits  should  receive  sharp  penalties. 
Toilet  paper  is  provided  by  the  quartermaster;  it  should  be 
in  rolls,  as  loose  sheets  blow  away.  The  last  duty  of  a 
moving  command  is  to  fill  in  the  sinks  before  the  day's 
march  is  commenced. 

Water-supply. — The  supply  of  water  must  be  carefully 
guarded,  frequently  inspected  as  to  pollution,  and  purified 
by  special  means  when  necessary.  Sources  of  supply  not 
considered  safely  potable  are  to  be  marked  "Bad,"  and  men 
drinking  from  such  sources  should  be  brought  before  a 
summary  court-martial.  When  the  supply  is  from  a  stream, 
immediate  protection  is  necessary  to  prevent  fouling  and 
muddying  by  men  and  animals,  especially  if  other  com- 
mands are  camped  lower  down.  The  various  points  desig- 
nated for  obtaining  drinking-water,  for  watering  animals,  for 
bathing,  and  for  laundry  purposes  are  to  be  suitably  marked 
and  the  sentries  placed  there  are  given  specific  instructions. 
The  formation  of  a  bucket  brigade,  the  digging  out  and 
lining  of  small  springs,  or  the  diversion  of  a  part  of  the 
stream  into  sunken  barrels  or  boxes  will  obviate  the  neces- 
sity for  men  to  enter  the  stream.  Animals  may  be  watered 

13 


194  MILITARY  HYGIENE 

from  buckets  or  troughs.  Bathing  can  be  adequately  per- 
formed by  the  men  pouring  water  over  one  another  from 
buckets.  The  washing  of  clothing  should  be  conducted  far 
enough  from  the  stream  so  that  the  soiled  water  will  not 
flow  back  into  it.  Men  must  be  prevented  from  urinating 
or  defecating  along  the  banks.  Drinking-water  containers 
should  have  a  cover  and  a  tap,  to  prevent  contamination  by 
some  one  ladling  the  water  out  with  a  dirty  vessel.  Each 
man  brings  his  own  cup,  for  a  common  cup  is  soon  filthy. 
Canteens  should  be  scalded  out  occasionally  and  care  exer- 
cised to  avoid  contamination  of  water  while  filling  these 
vessels.  If  the  drinking-water  must  be  boiled,  this  duty 
is  assigned  to  a  carefully  instructed  and  reliable  soldier. 
Bathing  is  to  be  insisted  upon  whenever  practicable.  If 
bath-houses  exist,  an  orderly  is  detailed  to  keep  the  place 
clean,  the  taps  turned  off,  and  the  ditches  and  pits  for  waste 
water  clear.  Where  streams  are  utilized,  bathing  places 
must  be  below  those  where  drinking-water  for  men  and 
animals  is  obtained.  In  fixed  camps  each  company  should 
have  a  bench,  with  a  sufficient  number  of  basins,  placed 
near  the  water  source  for  lavatory  purposes.  Laundry 
facilities  are  desirable:  the  simplest  of  these  takes  the  form 
of  a  fire  over  which  a  large  boiler  is  placed,  with  a  bench  or 
table  for  scrubbing  near  by.  In  wet  weather,  a  drying 
tent  is  a  necessary  adjunct. 

Messing. — Cooks  are  required  to  maintain  scrupulous 
cleanliness  in  everything  pertaining  to  the  operations  of 
the  mess.  The  men  should  be  made  to  wash  their  hands 
before  eating.  They  will  not  ordinarily  be  permitted  to 


SANITATION  OF  MARCHES,  CAMPS,  BATTLEFIELDS     195 

eat  in  their  tents.  Food  is  protected  from  flies  by  cover- 
ing or  screening.  Milk,  fruit,  bread,  and  foods  after  cook- 
ing are  subject  to  contamination  by  flies  or  by  careless  hand- 
ling. The  food  served  to  the  men  must  be  carefully  watched 
and  the  use  of  any  from  unauthorized  sources  prevented. 
Cooks  should  prepare  a  sufficiency  of  hot  soapy  water  for 
use  of  the  men  in  cleansing  their  mess  kits  after  meals. 
Garbage  of  marching  commands  is  usually  buried;  that  of 
fixed  camps  is  burned. 

Sutlers. — Peddlers  and  sutlers  are  a  nuisance.  Being 
imperfectly  under  control,  they  furnish  inferior  or  even 
infected  foods,  while  they  are  constantly  appealing  for  extra 
privileges  or  running  "boot  legs"  and  secret  gambling  places. 
The  men  are  better  off  without  them,  as  the  quartermaster 
and  the  exchange  officer  supply  all  reasonable  needs. 

Ice-box. — If  ice  is  available,  a  satisfactory  container  may 
be  made  for  it  by  burying  a  large  box  in  an  excavation. 
Stones  are  placed  in  the  bottom  to  take  up  the  water  and 
shelves  are  arranged  for  the  ice  and  food  stuffs. 

Care  of  Tents. — As  rain  may  occur  at  any  season,  tents 
should  usually  be  ditched  to  prevent  wetting  of  the  ground 
forming  the  tent  floor.  To  avoid  soil  moisture,  men  must 
be  kept  off  the  ground,  by  use  of  the  ponchos  in  one-night 
camps,  by  cots  or  raised  platforms  in  camps  of  longer  dura- 
tion. The  tent  walls  are  to  be  raised  every  day,  weather 
permitting,  so  that  sunlight  and  fresh  air  may  reach  every 
part  of  the  interior.  Ventilation  must  be  ensured  by  leav- 
ing the  door  flaps,  or  the  hood,  or  both,  open.  Canvas 
is  not  pervious  to  air  when  it  is  wet.  If  the  soil  is  dusty, 


196  MILITARY  HYGIENE 

tent  floors  should  be  sprinkled.  The  crowding  of  tents  with 
equipments  may  be  relieved  by  placing  certain  of  these 
(such  as  horse  equipage)  on  racks  outside.  Neatness  and 
order  should  be  maintained.  Bedding  and  extra  clothing 
should  be  frequently  sunned,  and  in  camps  of  some  per- 
manence tents  should  be  moved  laterally,  to  the  spaces  in- 
tervening between  them,  every  week  or  so,  to  obtain  the 
purifying  effects  of  the  sun  and  air  on  the  old  sites.  If 
shelter  tents  are  used,  the  men  must  not  be  permitted  to 
close  their  fronts.  A  poncho  may  be  extended  forward  to 
cut  off  rain  and  wind,  or  a  fire  built  in  front.  Overcrowding 
is  seldom  necessary.  In  fixed  camps,  8  men  to  a  conical  wall 
or  pyramidal  tent  make  the  proper  complement.  If  tents 
are  floored,  the  boards  should  be  loose  or  the  floor  in  sections, 
to  facilitate  cleansing  and  searching  for  contraband  articles. 
In  very  hot  weather,  light  coverings  of  tree  branches  over 
tents,  messing  places,  sinks,  and  picket  lines  form  a  grateful 
shade.  In  winter  camps,  huts  should  be  constructed  or 
tents  lined  and  floored. 

Police  of  Camp. — For  police  purposes  the  ground  within 
and  bordering  on  the  camp  should  be  equitably  divided. 
The  daily  cleansing  of  camp  is  to  be  inspected  by  the  proper 
officers  before  the  police  details  are  dismissed.  Special  at- 
tention must  be  given  to  the  edges  of  the  camp  area  proper, 
for  it  is  in  these  situations  that  piles  of  excrement,  human 
and  equine,  are  most  apt  to  be  deposited  and  to  remain 
undetected.  Picket  lines  should  be  kept  swept  all  day,  the 
manure  removed  each  morning,  and  the  ground  occasion- 
ally sprinkled  with  crude  oil  (or  even  burned  over)  to  pre- 


SANITATION  OF  MARCHES,  CAMPS,  BATTLEFIELDS     197 

vent  fly  propagation.  Dust  is  to  be  abated  by  sprinkling 
the  roads.  Flies  are  discouraged  by  destroying  the  garbage 
and  excrement  on  which  they  feed  and  breed.  Mosquito- 
breeding  areas  are  carefully  searched  for  and  drained  or 
oiled.  If  malaria  exists  or  is  feared,  troops  in  fixed  camps 
should  be  supplied  with  mosquito  bars.  Those  in  marching 
commands  will  probably  have  to  depend  on  the  daily  use 
of  quinin  for  the  prevention  of  this  disease. 

Personal  hygiene  must  be  carefully  looked  to.  Clean- 
liness of  person  and  clothing  is  to  be  required,  avoidance  of 
alcoholic  and  sexual  excesses  preached  and  practised.  Ennui 
should  be  combated  by  plenty  of  military  work,  and  if 
idleness  is  enforced — as  by  winter  storms — cheerfulness  is 
promoted  by  entertainments  of  various  sorts,  such  as  min- 
strels, lectures,  athletics,  music,  and  moving  pictures. 
The  sick  should  be  promptly  separated  from  the  well,  and 
when  their  ailments  are  of  a  contagious  nature  their  cloth- 
ing and  bedding  must  be  disinfected.  For  this  purpose 
Major  Munson  has  devised  a  light  and  compact  apparatus 
which  generates  formaldehyd  gas  by  the  addition  of  potas- 
sium permanganate  to  a  solution  of  the  gas  (Fig.  32).  Sick 
call  for  a  marching  command  is  usually  held  immediately 
after  arrival  in  camp.  For  a  fixed  camp  the  hour  is  ordi- 
narily 5  P.  M.  If  much  sickness  exists,  it  should  be  held 
twice  a  day. 

Responsibility  and  Inspections. — The  system  of  inspec- 
tion and  responsibility  for  camp  sanitation  must  be  thorough 
and  complete.  It  will  often  be  found  advisable,  in  conform- 
ity with  Paragraphs  291  and  292,  Field  Service  Regulations, 


198 


MILITARY  HYGIENE 


1913,  to  place  the  entire  sanitary  service  under  the  control 
of  the  chief  surgeon,  and  to  authorize  the  sanitary  inspector 
to  direct  the  abolition  of  conditions  prejudicial  to  health. 
Next  to  the  company  commander,  the  most  important  link 


Fig.  32. — Gas  generator,  for  disinfection  in  the  field.    Height,  8  inches; 
diameter,  6  inches;  weight,  5  pounds  (Munson). 

in  the  sanitary  chain  is  the  regimental  surgeon.  It  is  his 
duty  to  organize  the  personnel  assigned  to  such  functions 
into  a  sanitary  detachment  and  to  direct  it  in  the  perform- 
ance of  all  work  looking  to  disease  prevention.  When 


SANITATION  OF  MARCHES,  CAMPS,  BATTLEFIELDS     199 

necessary  the  sanitary  detachment  may  be  augmented  by 
civilians  employed  under  competent  authority,  or  by  details 
from  line  troops. 

Battlefields 

Evacuation  of  the  Sick. — The  great  changes  in  battle 
tactics  necessitated  by  increased  range  and  rapidity  of  fire 
have  largely  altered  the  conditions  to  be  met  by  sanitary 
troops,  as  well  as  by  those  of  the  line.  During  and  im- 
mediately subsequent  to  a  battle  the  efforts  of  all  concerned 
are  put  forth  to  achieve  victory  and  to  maintain  the  forces 
in  a  mobile  state.  And  since  the  wounded  and  the  sick 
embarrass  the  army  and  hamper  its  movements,  the  prompt 
evacuation  of  those  disabled  individuals  to  the  rear  is  of 
vastly  greater  importance  from  a  military  standpoint  than 
is  their  care.  The  sanitary  troops  of  modern  armies  are, 
therefore,  organized  and  trained  more  with  a  view  to  the 
removal  of  helpless  men  from  the  scene  of  action  than  to 
their  care,  although  the  latter  is  absolutely  essential  from 
political  as  well  as  humanitarian  considerations. 

Sanitary  Preparations. — Preparations  for  a  battle  include 
the  evacuation  of  all  encumbering  sick;  the  tentative  selec- 
tion of  locations  for  dressing  stations,  field  hospitals,  and 
other  sanitary  formations;  the  collection  of  extra  wagons, 
motor  cars,  and  litter  bearers  by  requisition  on  the  inhabit- 
ants; the  designation  of  lines  of  evacuation  for  the  wounded; 
the  arrangement  of  a  system  of  interrelation  between  the 
many  sanitary  units,  to  the  end  that  no  undue  strain  be 
placed  on  any  part  of  the  line  while  other  parts  are  rela- 
tively idle. 


200  MILITARY  HYGIENE 

Sanitary  Troops. — The  regulations  prescribe  that  a  total 
of  nearly  1000  officers  and  men  of  the  Medical  Department 
shall  be  assigned  to  each  division.  These  are  organized  into 
regimental  detachments,  three  field  hospitals,  four  ambulance 
companies,  and  a  reserve  depot  for  sanitary  supplies.  On 
the  line  of  communications  there  are  nearly  700  more  sani- 
tary troops  per  division.  And  as  these  numbers  are  notori- 
ously insufficient  to  handle  battle  casualties,  the  regulations 
further  authorize  the  employment  of  bandsmen  and  impressed 
or  hired  civilians  as  litter  bearers  at  the  front,  as  well  as  of 
members  of  the  Red  Cross  Society  in  evacuation  hospitals 
and  in  other  units  of  the  sanitary  column. 

Lines  of  Sanitary  Aid. — Sanitary  aid  from  front  to  rear  is 
as  follows:  (1)  The  firing  line,  where  regimental  medical 
officers  and  Hospital  Corps  men  are  placed  at  intervals  if 
shelter  exists;  (2)  aid  stations,  one  to  each  regiment,  estab- 
lished by  its  sanitary  personnel  as  close  as  conditions  of 
terrain  will  permit;  (3)  dressing  stations,  one  per  brigade 
usually,  formed  by  ambulance  companies;  (4)  stations  for 
slightly  wounded  (one  for  a  division);  (5)  field  hospitals;  (6) 
sanitary  column.  At  night  all  sanitary  stations  are  marked 
by  green  lanterns. 

Care  of  Wounded. — The  regimental  sanitary  personnel 
is,  as  a  matter  of  course,  first  to  have  work.  The  wounded 
begin  to  trickle  back,  many  with  injuries  already  dressed 
with  the  contents  of  a  first  aid  packet,  which  soldiers  in 
campaign  quickly  learn  to  value  and  to  apply.  Diagnosis 
tags  are  affixed  by  the  first  medical  officer  who  handles  the 
cases.  During  lulls  in  the  enemy's  fire  or  where  the  ground 


SANITATION  OF  MARCHES,  CAMPS,  BATTLEFIELDS     201 


Fig.  33. — Sanitary  aid  stations  and  lines  of  evacuation  (Straub). 


202  MILITARY  HYGIENE 

affords  sufficient  protection,  litter  squads  of  two  men  each 
are  pushed  forward  from  the  dressing  stations  to  find  and 
carry  back  helpless  wounded.  Meanwhile,  those  among 
the  less  severely  injured  who  are  able  to  walk,  are  availing 
themselves  of  every  opportunity  to  obey  that  powerful  im- 
pulse which  urges  a  wounded  man  to  seek  the  rear.  Lines 
of  sanitary  aid  are  marked  by  ambulance  guidons  or  other 
easily  understood  symbols  visible  from  the  front,  and  the 
streams  of  wounded  are  thus  led  to  the  various  stations. 
The  dressing  stations  are  established  as  close  to  the  firing 
line  as  the  necessary  conditions  of  comparative  protection 
from  rifle  and  cannon  fire,  with  water-supply  and  access  by 
road,  will  permit.  Wounded  men  are  sent  back  from  these 
stations  by  ambulances,  emptied  ammunition  and  supply 
wagons  and  litter  bearers,  to  the  next  line  of  aid,  namely, 
the  field  hospitals,  from  which  they  are  evacuated  by  the 
sanitary  transport  column  pertaining  to  the  line  of  commu- 
nications. At  the  conclusion  of  the  battle  the  successful 
commander  is  required  to  organize  a  thorough  search  of  the 
field  for  the  collection  of  the  wounded  and  the  dead. 

Water-supply. — Wounded  men  are  always  tormented  by 
thirst,  chiefly  because  of  their  loss  of  blood.  The  violent 
exertions  required  of  troops  in  battle  induce  a  rapid  loss  of 
water  from  their  bodies  through  the  perspiration.  These 
reasons  render  it  imperative  that  arrangements  shall  be 
made  for  a  supply  of  drinking-water  at  such  times.  When 
water  is  not  readily  available  from  streams,  a  system  of 
distribution  should  be  arranged,  regulated,  and  supervised. 
Under  the  stress  of  battle  conditions  it  is  likely  that  we  may 


SANITATION  OF  MARCHES,  CAMPS,  BATTLEFIELDS     203 

be  obliged  to  ignore  questions  of  purity  and  to  allow  the  men 
to  drink  from  any  available  source.  On  the  other  hand, 
it  will  often  be  possible  to  form  regimental  sanitary  water 
detachments,  whose  duty  shall  be  to  provide  a  supply  for 
troops  in  action.  This  duty  might  be  carried  out  by  details 
from  the  reserves.  If  possible  to  purify  the  water  before 
issue,  this  may  be  done  by  Darnall  filters,  of  which  three 
ordinarily  suffice  for  a  regiment.  These  may  be  trans- 
ported on  a  pack  mule.  A  capable  Hospital  Corps  man 
should  be  in  charge  of  the  filters  and  their  operation.  For 
food  we  may  have  to  rely  on  the  reserve  ration  alone. 

Casualties. — The  average  percentage  of  casualties  for 
one  day  of  battle  (based  on  modern  wars  and  including  the 
sick  as  well  as  the  enemy's  wounded  who  may  fall  into  our 
hands)  may  be  considered  roughly  as  12  per  cent.  This 
percentage  may  not  be  reached  for  the  whole  army,  but  is 
likely  to  be  exceeded  in  some  organizations.  The  ratio  of 
killed  to  wounded  is  about  1  to  4.  Of  100  men  hit,  it  is 
estimated  that: 

20  will  be  killed. 

15  will  require  transport  lying  down. 

35  will  require  transport  sitting  up. 

5  will  be  too  desperately  wounded  to  bear  transportation. 
25  will  be  able  to  walk. 

The  location  of  the  wounds  will  be  about  as  follows: 

Per  cent. 

Head  and  neck 16 

Trunk 30 

Upper  extremities 26 

Lower  extremities .28 


204  MILITARY  HYGIENE 

Wounds  will  be  caused  by: 

Per  cent. 

Rifle  missiles 84 

Shell  fire  (mostly  shrapnel) 14 

Bayonet 1 

Saber,  lance,  etc 1 

Note. — The  figures  in  the  foregoing  tables  are,  neces- 
sarily, mere  approximations. 

Identification  of  Dead. — The  identification  of  the  dead  is 
required  by  regulations,  and  is  facilitated  by  the  fact  that 
officers  and  men  wear  round  aluminum  tags  (on  which  their 
names  and  organizations  are  stamped)  suspended  from  their 
necks.  By  the  terms  of  the  International  Red  Cross  Con- 
vention, the  commander  left  in  possession  of  the  field  after 
a  battle  is  charged  with  the  duty  of  identifying  the  enemy's 
dead  and  of  transmitting  their  identification  tags,  with  such 
valuables  as  may  be  found  upon  them,  to  the  proper  authori- 
ties for  return  to  their  own  country. 

Disposal  of  the  Dead. — The  melancholy  duty  of  disposal 
of  the  dead  falls  to  the  Quartermaster  Corps,  whose  officers 
employ  captives,  neighboring  inhabitants,  or  troops  detailed 
for  this  purpose.  Public  sentiment  prefers  burial,  although 
cremation  is  far  more  desirable.  Captured  trenches  may  be 
utilized  for  either  method.  If  cremation  is  used,  it  is  aided 
by  crude  oil,  coal-tar,  or  such  other  high  inflammables  as 
may  be  available.  In  case  of  burial  the  clothing  is  removed, 
for  the  reason  that  it  delays  decomposition,  and  is  burned 
to  prevent  possible  contagion.  The  identification  tag  is 
fastened  to  the  body  by  copper  wire,  for  the  sake  of  subse- 
quent recognition  in  case  of  disinterment.  The  burial  trench 


SANITATION  OF  MARCHES,  CAMPS,  BATTLEFIELDS     205 

should  be  9  or  10  feet  deep  and  7  feet  wide.  Tree  branches 
or  rocks  are  placed  in  the  bottom  to  facilitate  drainage  and 
the  bodies  are  placed  in  several  layers,  with  lime  between, 
if  this  substance  can  be  obtained.  Dead  animals  must 
likewise  be  burned  or  buried. 


CHAPTER    XII 
THE  DISPOSAL  OF  WASTES 

Wastes. — Substances  of  various  kinds  which  are  no  longer 
of  value  to  man,  but  which,  on  the  other  hand,  may  be  detri- 
mental to  him,  must  be  disposed  of  in  one  way  or  another. 
Broadly  speaking,  such  substances,  or  waste  matters,  may 
be  solid  or  liquid.  The  term  "refuse"  is  often  applied  to 
all  solid  wastes  not  carried  away  by  sewers,  to  distinguish 
these  from  "sewage"  proper.  The  quantity  of  refuse  which 
requires  disposal  may  be  very  great.  In  New  York  City 
it  is  estimated  that  these  solids  amount  to  one  ton  per  capita 
for  the  year. 

Classification. — Wastes  may  be  conveniently  classed  as 
follows,  having  due  regard  to  their  importance  with  rela- 
tion to  the  public  health: 

1.  Human  excrement  (feces  and  urine). 

2.  Solid  kitchen  refuse  (garbage). 

3.  Liquid,  non-excrementitious  house  wastes  (from  kitchen 
sinks,  laundry  tubs,  baths,  basins,  etc.). 

4.  Manure  (horses,  cattle,  swine). 

5.  Street  sweepings. 

6.  Rubbish    (house    trash,    waste    paper,    brush,    grass, 
leaves,  etc.). 

7.  Storm  waters. 

8.  Ashes. 

206 


THE  DISPOSAL  OF  WASTES  207 

For  our  purposes,  the  topic  under  discussion  must  be 
treated  with  respect  to  the  widely  differing  conditions  of 
garrison  and  camp  life. 

The  Disposal  of  Wastes  in  Garrison 

The  Ideal  Method. — As  previously  intimated,  the  ideal 
method  of  disposal  for  all  kinds  of  waste  matters  is  their 
destruction  by  fire,  which  leaves  a  single  unobjectionable 
residue,  namely,  ashes.  But  as  this  method  is  usually  in- 
applicable, at  least  in  part,  other  methods  must  be  consid- 
ered as  well. 

Human  Excrement. — Experience  has  demonstrated  that 
human  excrement  is  not  only  a  public  nuisance,  but  it  is  a 
public  danger.  It  must,  therefore,  be  destroyed  or  removed 
as  promptly  as  possible.  Methods  for  its  disposal  are  as 
follows : 

(A)  The  old-fashioned  privy,  with  its  pestilential  odors,  its 
ground  and  water  pollution,  and  its  feces-food-flies  relation, 
should  no  longer  have  a  place  in  any  garrisoned  post.     Privy 
pits  are  better  than  indiscriminate  droppings,   and  must 
perhaps  still  be  employed   in  rural  districts,   although  it 
is   possible   to   substitute   better   measures   for  them.     If, 
for  any  reason,  privies  must  be  used  in  a  military  com- 
munity, their  vaults  should  be  waterproofed  by  a  tight 
cement  lining  and  their  contents  adequately  protected  from 
flies  and  rats. 

(B)  The  dry  earth  system  (Fig.  34),  which  is  employed  by 
us  in  some  Philippine  stations,  is  much  superior  to  the  ordi- 
nary privy  pit.    This  consists  of  pails  or  pans  placed  beneath 


208 


MILITARY  HYGIENE 


closet  seats  to  receive  the  discharges,  which  latter  are 
promptly  covered  by  dry,  powdered  earth,  ashes,  or  lime. 
To  be  successful,  the  following  points  are  to  be  observed: 
(a)  The  pail  must  fit  close  up  to  the  seat,  that  urine  may  be 
voided  into  and  not  outside  of  it.  (6)  Flies  must  be  excluded 
by  making  the  closet  box  fly-tight  and  providing  the  seat 
with  a  self-closing  cover,  (c)  Enough  earth  must  be  used  to 
absorb  the  liquids  and  to  act  as  a  deodorant,  (d)  The  fecal 


Fig.  34. — Dry  earth  closet:  1,  Self-closing  seat  cover;  2,  fly-tight  trap- 
door; 3,  pan;  4,  supports  for  pan. 

matter  must  be  removed  daily  (or  nightly)  and  properly 
disposed  of  (as  by  burial,  incineration,  or  dumping  into  the 
sea).  The  pail  may  be  removed  and  replaced  by  a  clean 
one,  or  its  soiled  areas  may  be  sprinkled  with  crude  petro- 
leum or  some  other  disinfectant. 

(C)  Public  Health  Service  Latrine. — Officers  of  the 
United  States  Public  Health  Service  have  devised  a  simple 
apparatus  consisting  of  two  barrels  or  tanks,  upon  the 


THE  DISPOSAL  OF  WASTES 


209 


larger  of  which  a  closet  seat  is  superimposed.  The  larger 
receptacle  is  partly  filled  with  water,  up  to  a  point  where  a 
pipe  connection  with  the  smaller  one  takes  care  of  any 
overflow  (Fig.  35).  Flies  and  mosquitoes  are  repelled  by 


Gntisjihsher 


Fig.  35. — Closet  devised  by  offieers  of  the  United  States  Public  Health 
Service  (Lumsden,  Roberts,  and  Stiles). 

screening,  a  self-closing  seat  cover,  and  a  little  oil  on  the 
water's  surface.  This  apparatus  liquifies  the  fecal  matter, 
reduces  its  volume,  and  diminishes  its  odor.  The  tanks  need 
emptying  but  seldom,  when  the  removed  material  may  be 
disposed  of  by  any  approved  method. 

14 


210 


MILITARY  HYGIENE 


(D)  Destruction  by  Fire. — Excreta  may  be  incinerated  by 
any  one  of  the  numerous  destructors  which  have  been  devised 
for  this  purpose.  Some  of  these  are  neat  in  design,  correct  in 


Fig.  36. — Incinerator  for  excreta;  United  States  Incinerator  Co.  type. 

principle,  and  effective  in  application.  The  operation  of 
any  type  must  be  in  charge  of  a  careful  and  conscientious 
man,  lest  the  excreta  be  carelessly  handled  or  a  nuisance 


THE  DISPOSAL  OF  WASTES  211 

develop  as  a  result  of  imperfectly  combusted  gases.     Figure 
36  shows  one  form. 

(E)  Cesspools. — For  isolated  buildings,  cesspools  (covered 
pits)  are  sometimes  utilized  for  the  reception  of  fecal  matter, 
together  with  liquid  house  wastes.     The  buildings  are  sup- 
plied with  plumbing,  the  sewage  from  which  has  its  outfall 
into  the  cesspool  instead  of  a  stream.      Cesspools  should  be 
made    water-tight    by    concreting    them.     Their    contents 
must  be  removed  by  an  "odorless  excavator"  wagon  or  the 
liquid  overflow  (effluent)  disposed  of  by  absorption  in  plowed 
land. 

(F)  Sewerage  System. — The  method  now  preferably  em- 
ployed by  modern  communities  is  removal  by  water  carriage, 
that   is,   sewerage.     Even   this   has   its  disadvantages,  as, 
though  the  filth  is  removed  from  dwellings,  its  discharge 
into  streams  may  give  rise  to  offensive  or  dangerous  condi- 
tions.    Nevertheless,  it  is  the  method  of  election. 

Sewers. — Sewage  collected  from  houses  must  be  carried 
away  and  disposed  of  in  some  manner  that  will  not  create 
a  nuisance  nor  constitute  a  menace  to  health.  In  the  con- 
struction of  sewers  for  the  conveyance  of  liquid  and  semi- 
solid  wastes,  the  first  point  is  the  estimation  of  the  expected 
quantity.  The  amount  of  water  used  equals  the  amount 
of  sewage,  and  the  size  of  main  and  branch  sewers  is  based 
thereon.  In  general,  a  minimum  of  8  inches  in  diameter 
is  used  for  mains,  of  6  inches  for  branches.  If  the  amount 
of  sewage  is  small,  circular  pipes  are  satisfactory.  If  very 
inconstant  in  volume  (as  when  storm  waters  are  admitted), 
ovate  pipes,  with  the  narrower  part  below,  are  best.  Sewers 


212  MILITARY  HYGIENE 

of  less  than  24  inches  diameter  are  generally  made  of  vitri- 
fied earthenware;  if  over  24  inches,  they  are  best  constructed 
of  concrete,  or  brick  set  in  cement  and  lined  therewith.  The 
direction  of  a  sewer  should  be  as  straight  as  possible  and 
the  fall  equable,  without  sudden  changes  of  level.  Small 
sewers  require  a  greater  gradient  than  large  ones.  Man- 
holes should  be  provided  for  ventilation  and  cleansing. 
Sewer  air — or  "gas,"  as  it  is  sometimes  mistakenly  termed— 
may  be  offensive,  but  is  not  liable  to  transmit  disease. 

Sewage  Disposal. — Sewage  may  be  disposed  of  in  a  variety 
of  ways;  these  are: 

(1)  Discharge  into  the  sea  or  other  waters. 

(2)  Chemical  treatment. 

(3)  Irrigation  (sewage  farming). 

(4)  Biologic  methods. 

(a)  "Contact"  filtration. 

(b)  "Percolating"  filtration. 

(c)  Septic  tank. 

Of  these,  the  first  is  simplest  and  cheapest,  but  cannot 
always  be  employed  because  of  the  fouling  of  harbors  and 
water-courses.  Chemical  treatment  is  too  expensive.  The 
use  of  sewage  as  a  farming  irrigant  does  very  well  when  the 
quantity  is  small,  and,  if  the  method  is  properly  carried  out, 
the  risk  of  transmitting  disease  thereby  is  but  slight. 

Biologic  Methods. — The  term  "biologic,"  as  used  in  this 
connection,  means  that  the  sewage  is  acted  upon  by  certain 
forms  of  life,  in  this  case  some  of  the  microscopic  vegetable 
germs  known  as  nitrifying  bacteria.  These  attack  the  or- 
ganic solids  and  largely  liquefy  them,  while  they  destroy 


THE  DISPOSAL  OF  WASTES  213 

most  of  the  disease  germs  which  may  be  present.  Contact 
filtration  is  performed  by  large  beds  of  broken  stone,  from  3 
to  5  feet  deep.  These  are  rapidly  filled  with  the  sewage, 
which  is  allowed  to  stand  for  several  hours,  during  which 
the  harmless  bacteria  referred  to  are  active.  Percolating 
filters  are  beds  similar  to,  but  deeper  than,  contact  ones,  over 
.the  surface  of  which  the  sewage  is  sprinkled  automatically. 
A  septic  tank  is,  practically,  a  scientifically  constructed  cess- 
pool. The  present  consensus  of  expert  opinion  is  that  a 
combination  of  biologic  methods  produces  the  best  results 
in  the  purification  of  sewage.  For  example,  septic  tank 
treatment,  followed  by  percolating  filtration,  produces  an 
effluent  sufficiently  purified  to  be  safely  discharged  into  some 
water-course. 

Drainage,  as  distinguished  from  sewerage,  means  the  re- 
moval of  surface  water  as  well  as  the  surplus  moisture  of 
the  soil.  It  is  desirable  to  have  a  separate  system  of  drains 
for  this  purpose  rather  than  to  trust  to  the  sewers,  which 
latter  may  be  choked  or  damaged  by  storm  waters. 

Garbage. — With  careful  and  interested  attendants  it  is 
possible  to  dispose  satisfactorily  of  garbage  in  kitchen  ranges 
or  basement  furnaces,  thus  obviating  the  need  for  cans  and 
slop  wagons.  As  yet,  however,  the  first  condition  is  rarely 
met,  and  it  is  usually  necessary  to  collect  such  refuse  in  cans 
and  to  convey  it  to  some  point  sufficiently  remote,  where  a 
general  incinerator  (such  as  the  Morse-Boulger  destructor, 
Fig.  37)  is  located.  Such  an  apparatus  can  readily  cremate 
a  dead  horse. 

Small  incinerators  designed  for  institutional  use  may  now 


214 


MILITARY  HYGIENE 


be  obtained  and  installed  in  barracks,  hospitals,  and  the 
like.  These  are  capable  of  caring  for  the  house  rubbish  as 
well  as  for  the  garbage  (Fig.  38).  In  the  absence  of  house 
apparatus,  garbage  is  placed  in  cans  until  such  time  as  the 
cart  makes  its  daily  rounds. 

Separation  of  Components. — It  is  important  to  keep 
garbage  proper  in  cans  separate  from  ashes  and  other  in- 
destructible materials,  as  the  former  is  to  be  incinerated, 


Flue. 


Longitudinal 

Fig.  37. — Morse-Boulger  destructor,  longitudinal  section. 

with  which  action  the  latter  interferes.  An  exception  to 
this  rule  is  in  the  disposition  of  emptied  food  cans,  which 
should  be  treated  as  garbage  for  the  reason  that  much  organic 
matter  remains  in  their  interiors.  An  even  more  important 
consideration  for  such  separation  is  that  ashes  must  be  de- 
posited on  a  dump,  or  used  for  filling  up  some  ground  depres- 
sion, or  even  employed  on  roads  and  paths,  in  any  of  which 
situations  decomposing  organic  refuse  would  be  highly 
objectionable.  Liquids  should  be  strained  out  and  dis- 


THE  DISPOSAL  OF  WASTES 


215 


posed  of  in  the  kitchen  sink;  thus,  only  the  solid  garbage 
need  be  placed  in  the  cans. 

Cans,  Stands,  and  Covers. — Garbage  cans  should  be  ele- 
vated on  stands  a  foot  or  so  above  the  ground  in  order  that 
fouling  of  the  latter  may  be  promptly  detected  and  remedied 
(Fig.  39).  Cans  and  stands  should  be  kept  whitewashed 


Fig.  38. — Incinerator  for  house  wastes  (Incinerite  Co.). 

for  the  sake  of  neatness  and  cleanliness.  That  flies  and 
rats  may  not  be  attracted  and  fed,  it  is  important  to  have 
well-fitting  covers  for  the  cans  and  to  require  these  to  be 
properly  used.  When  covers  warp  so  that  they  no  longer 
fit,  they  may  be  replaced  by  others  of  wood,  made  broad 
enough  to  overlap  the  sides  a  few  inches  and  furnished  with 


216  MILITARY  HYGIENE 

a  handle.     Several  cleats  nailed  on  the  under  side  will  pre- 
vent the  wooden  covers  from  being  dislodged  by  the  wind. 

Liquid  house  wastes  from  kitchen  sinks,  bathtubs,  and 
the  like  are  cared  for  by  the  sewerage  system,  if  one  exists. 
In  the  rare  event  of  its  absence  in  a  military  community, 
such  wastes  must  be  carried  away  in  open  drains  or  removed 
by  garbage  carts.  A  large  amount  of  grease  passes  through 


Fig.  39. — Garbage  cans,  with  wooden  covers,  on  stand. 

pipes  from  kitchen  sinks  and  may  choke  them.  An  open 
"grease  trap,"  from  which  the  material  may  be  skimmed,  is 
sometimes  installed.  Failing  this,  a  strong  hot  solution 
of  lye  should  be  flushed  through  the  sink  occasionally. 

Manure. — The  disposal  of  manure  is  a  question  which 
may  have  to  be  handled  differently  at  each  station.  As 
this  material  is  chiefly  responsible  for  the  propagation  of 
house  flies,  its  complete  destruction  by  fire  is  desirable. 


THE  DISPOSAL  OF  WASTES  217 

But,  on  the  other  hand,  manure  is  of  considerable  economic 
value  as  a  land  fertilizer,  and  it  will  usually  be  found  that  a 
compromise  must  be  effected  between  sanitation  and  utility. 
Some  officers  of  mounted  troops  seem  to  regard  horse  manure 
as  a  purely  beneficent  substance  and,  therefore,  ignore  its 
objectionable  qualities.  The  number  of  eggs  laid  by  a 
single  fly  is  very  large,  and  one  horse  will  supply  enough 
manure  to  furnish  flies  for  an  extended  neighborhood.  A 
period  of  ten  to  fourteen  days  is  required  for  the  evolution 
of  the  adult  fly  from  the  egg,  through  the  larval  stage  of 
the  common  maggot. 

Manure  Disposal. — Manure  should  not  be  allowed  to 
accumulate,  but  should  be  removed  from  stables  daily  to 
a  dumping  ground  fairly  remote  from  habitations  and  in  the 
direction  of  the  prevailing  summer  winds.  Only  enough  of 
this  substance  should  be  accumulated  for  fertilizing  pur- 
poses and  all  excess  should  be  burned.  Where  the  smoke  will 
not  prove  annoying,  the  heaps  of  manure  may  be  allowed 
to  smolder,  and  the  fumes  blowing  over  the  fertilizer  supply 
(if  this  is  properly  placed  with  reference  to  the  wind)  will 
aid  in  keeping  flies  away.  If  more  rapid  destruction  is  desir- 
able, this  may  be  accomplished  in  a  destructor,  or  a  crema- 
tory pit,  or  upon  a  rough  gridiron  of  old  rails  or  piping. 
When  used  as  a  fertilizer  during  fly  season  the  manure 
should  be  promptly  spread  and  worked  into  the  soil.  If  it 
is  not  possible  to  remove  the  manure  every  day,  a  fly-proof 
vault  should  be  built  at  the  stable  for  its  temporary  storage. 

Sweepings  and  Rubbish. — Street  sweepings  generally  con- 
tain so  much  soil  that  it  is  difficult  to  dispose  of  them  by 


218  MILITARY  HYGIENE 

incineration.  If  their  content  of  organic  matter  is  relatively 
small,  they  may  be  deposited  on  the  dump  or  used  as  filling. 
If  the  sweepings  are  chiefly  horse  manure,  they  should  be 
handled  with  that  substance.  Rubbish  collected  from  houses 
is  placed  in  cans  or  other  proper  receptacles,  whence  it  is 
removed  to  the  incinerator.  Dead  grass,  leaves,  and  the 
like  are  carted  away  or  burned  in  any  convenient  situation. 
Dump. — It  is  generally  necessary  to  have  some  place 
set  apart  as  a  dumping-ground  for  solid  wastes  which  cannot 
be  burned.  The  location  of  the  dump  should  be  well  re- 
moved from  habitations  and  inconspicuous.  No  organic 
materials  should  find  a  place  there.  A  caretaker  should 
be  assigned  to  keep  it  in  a  proper  state  of  police. 

The  Disposal  of  Wastes  in  Camps 

Excreta. — Incineration. — As  previously  emphasized,  the 
complete  destruction  of  excreta  by  fire  is  the  ideal  method 
for  the  disposal  of  these  unpleasant  and  dangerous  wastes. 
Many  kinds  of  incinerators,  fixed,  portable,  and  ambulant, 
have  been  devised  for  this  purpose,  and  some  of  these  have 
been  found  highly  efficient.  The  essentials  for  success  with 
any  type  are  plenty  of  fuel  and  efficient  attendants.  When 
carelessly  performed,  incineration  may  be  more  offensive 
than  any  other  means  of  disposal.  A  slow  fire,  wet  wood 
as  fuel,  or  failure  to  utilize  the  auxiliary  combustion  grate 
(which  some  types  need  for  the  destruction  of  the  offensive 
gases)  will  drive  off  heavy  urinous  odors  which  hang  over 
all  parts  of  the  camp.  The  shallow  urinal  pans  sometimes 
overflow  and  foul  the  ground.  Some  types  become  so  hot 


THE  DISPOSAL  OF  WASTES  219 

that  the  device  cannot  be  used  for  several  hours  after  burn- 
ing out. 


Fig.  40. — Incinerator  for  excreta,  Quartermaster  Corps  type. 

Types  of  Incinerators. — The  Bissell  and  the  Lewis  and 
Kitchen  patents  are  mounted  on  wheels,  with  the  idea  that 


220  MILITARY  HYGIENE 

they  may  accompany  moving  commands;  they  are  efficient 
as  incinerators,  but  not  practicable  as  to  mobility.  The 
Quartermaster  Corps  has  devised  and  issued  a  type  (Fig.  40) 
which  closely  resembles  the  patented  models  of  McCall  and 
Conley.  Harris,  of  the  Medical  Reserve  Corps,  has  in- 
vented one  which  is  simpler  and  more  portable  than  most 
others,  while  perhaps  equalling  the  best  in  efficiency  (Fig.  41). 


Fig.  41. — Incinerator  for  excreta,  Harris  type. 

Reed  Trough. — This  is  made  of  galvanized  iron,  curved 
to  facilitate  cleansing,  and  deeper  at  one  end  for  ready 
emptying.  It  is  long  enough  to  accommodate  seven  seats, 
which  latter  have  self-closing  covers.  The  covers  are 
made  to  fall  shut  of  their  own  weight  by  nailing  a  board 
longitudinally  above  the  seat  at  a  point  which  allows 
them  to  be  raised  less  than  90  degrees.  This  board  also 
performs  the  valuable  function  of  preventing  men  from 
standing  on  the  seat.  In  Artillery  Reserve  camps  and  other 


THE  DISPOSAL  OF  WASTES  221 

favorable  situations,  it  may  be  possible  to  place  their  out- 
lets directly  over  sewer  manholes.  Usually  their  contents 
must  be  pumped  by  hand  into  a  tank  wagon  and  removed 
to  the  place  of  final  disposal.  This  latter  may  be  a  sewer,  a 
stream,  the  sea,  an  incinerator,  or  a  burial  pit.  If  crude  oil 
is  used  to  cover  the  surface  of  the  liquid  ia  the  trough,  the 
tank  wagon  may  even  discharge  its  contents  upon  the  ground, 
as  the  oil  keeps  flies  away  and  acts  as  a  deodorizer. 

Sinks  or  Latrines.— Company  sinks  (called  also  latrines) 
are  ordinarily  15  feet  long,  2  feet  wide,  and  6  feet  deep;  with 
large  organizations  they  may  have  to  be  somewhat  longer. 
They  are  placed  in  line  on  that  flank  of  the  camp  which  is 
opposite  the  kitchens  and  in  a  situation  sufficiently  elevated 
so  that  storm  waters  will  not  flow  into  them.  If  any  such 
risk  exists,  drainage  ditches  should  be  dug  around  them. 
Moreover,  they  must  be  far  enough  from  the  water-supply 
to  obviate  any  danger  of  polluting  the  latter. 

Box  Seats. — In  fly  season,  seats  with  lids  should  be  pro- 
vided, and  the  open  space  beneath  the  seats  is  to  be  boxed 
in  (or  covered  to  the  ground  with  muslin  or  sacking).  In 
the  preparation  of  these  box  seats  it  is  desirable  to  pay 
attention  to  the  following  points:  (1)  Make  seat  holes  oval 
instead  of  round;  (2)  leave  J  inch  space  at  hinges  of  seat 
covers  to  allow  for  swelling  of  wood  when  wet  by  rains  or 
cleansing  solutions;  (3)  nail  a  piece  of  galvanized  iron  or  tin 
below  and  in  front  of  each  seat  to  direct  urine  into  the  pit; 

(4)  slope  back  of  box  well  to  rear,  to  avoid  soiling  with  feces; 

(5)  if  the  soil  crumbles,  rest  the  box  on  wooden  sleepers 
and  place  a  foot  board  at  the  pit  edge.     The  boxing  should 


222 


MILITARY  HYGIENE 


be  removed  every  day  and  the  pit  burned  out.  This  will 
require  about  5  pounds  of  hay  or  straw,  with  1  or  2  gallons 
of  oil.  The  oil  should  be  sprinkeld  on  the  pit  walls  as  well 
as  upon  the  discharges. 

If,  for  any  reason,  pit  covers  cannot  be  had,  crude  oil, 
kerosene,  or  chlprid  of  lime,  well  distributed  over  the  sides 


PLAN. 


Fig.  42. — Box  seat  cover  and  urine  trough  for  company  sink. 
Note  shape  of  seat,  self-closing  cover,  slope  of  back,  and  tin  strip. 
(After  Straub  and  Miller.) 


and  bottoms  of  sinks,  will  greatly  discourage  the  approach 
of  flies.  Ordinary  lime — unless  freshly  slaking  and  active — 
is  not  particularly  objectionable  to  the  insects.  In  the 
absence  of  the  chemical  agents  mentioned,  a  supply  of  dry, 
powdered  earth,  which  is  a  good  deodorizer,  is  maintained, 


THE  DISPOSAL  OF  WASTES 


223 
Each 


and  a  shovel  or  scoop  is  provided  for  handling  it. 
soldier  is  required  to  cover  his  discharges  at  once. 

Pole  Seat. — When  a  board  seat  is  not  available,  one  must 
be  improvised  out  of  a  straight,  smooth  pole  resting  on  sup- 
ports of  crossed  timbers  (Fig.  43). 

fc 


Fig.  43. — Company  sink,  cross-section,  showing  pole  seat,  brush  screen- 
ing, and  ditching. 

In  some  situations  a  rocky  site  or  high  ground  water  may 
not  permit  of  deep  pits.  In  such  case  shallow  sinks  will  do, 
if  the  pits  are  oiled  and  burned  out  regularly.  Shelter  is 
to  be  provided  by  tentage,  boards  or  brush,  and  privacy 
ensured  by  screens  of  canvas,  tree  branches,  or  burlap. 
Where  brush  is  used  for  roofing,  there  is  danger  of  fire  when 
the  pit  is  burned  out.  Sinks  should  be  filled  in  when  their 
contents  approach  within  2  feet  of  the  surface. 


224  MILITARY  HYGIENE 

Disposal  of  Urine. — If  men  are  allowed  to  urinate  directly 
into  the  sink,  they  will  soil  the  seats  of  a  closed  pit  or  foul 
the  edge  of  an  open  one.  It  is,  therefore,  highly  desirable 
to  make  separate  provision  for  the  urine,  and  this  is  done 
by  constructing  a  trough  at  one  end  or  in  rear  of  the  sink  and 
draining  into  the  latter.  The  trough  may  be  made  of  lumber, 
galvanized  iron,  tin  from  empty  cans,  tarred  paper,  or  even 
of  muslin  stiffened  and  rendered  impervious  with  paint  or 
tar.  It  is  important  to  scrub  this  daily  with  an  old  broom 
(to  prevent  the  deposition  of  ammoniacal  salts)  and  to  keep 
it  well  sprinkled  with  oil.  A  less  satisfactory  device  for 
the  disposal  of  the  urine  is  a  shallow  trench,  about  3  feet 
long  and  1  foot  wide,  dug  at  the  edge  of  the  sink  and  sloping 
rapidly  to  the  latter.  The  trench  is  partly  filled  with  straw 
or  brush  to  prevent  spattering,  and  such  materials  are 
raked  into  the  pit  and  burned  regularly.  The  men  using 
the  trench,  bestride  it.  Petroleum  is  used  to  keep  the  trench 
sweet  and  free  from  flies. 

Urinal  Cans. — Men  awakened  from  sleep  at  night  by  a 
desire  to  urinate  will  simply  step  outside  their  tents  to  re- 
lieve themselves  upon  the  ground  unless  it  is  made  easy  for 
them  to  be  cleanly  in  this  respect.  Urinal  cans  or  tubs 
should,  therefore,  be  placed  in  the  company  streets  at  dusk, 
set  up  at  a  convenient  height  and  their  location  marked  by 
lanterns.  This  procedure  constitutes  one  of  the  duties  of  a 
latrine  orderly,  who  is  responsible  for  the  cleanliness  and 
care  of  the  receptacles.  In  the  morning  the  cans  are  emptied 
into  the  sink,  after  which  they  are  rinsed  out  with  milk  of 
lime  or  crude  oil  in  water.  Officers  will  find  the  use  of  a  tin 


THE  "DISPOSAL  OF  WASTES  225 

or  bottle  for  night  urine  to  be  a  comfort.  Such  a  vessel 
may  be  emptied  into  the  sink  and  washed  out  in  the  morning. 

Latrine  Orderlies. — It  is  necessary  to  have  an  orderly 
assigned  to  each  latrine,  whose  duties  will  be :  (a)  To  be  pres- 
ent at  all  times  during  the  day  while  troops  are  in  camp; 
(b)  to  see  that  deposits  are  promptly  covered;  (c)  to  have 
seats  clean  and  covers  down;  (d)  to  keep  the  urinal  trough 
or  trench  in  proper  condition;  (e)  to  set  out  the  urinal  cans  at 
evening  and  to  remove  and  cleanse  them  after  reveille;  (/) 
to  maintain  the  surroundings  in  efficient  police;  (g)  to  fill, 
light,  and  set  up  the  lanterns  at  latrine  and  urinal  cans; 
(h)  to  report  any  infractions  of  the  rules  of  sanitation  and 
decency.  The  men  must  be  made  to  realize  that  the  duties 
of  a  sanitary  orderly  are  highly  honorable,  and  that,  involv- 
ing (as  they  do)  the  care  of  the  health  of  all,  they  are  in  the 
highest  degree  important.  If  officers  discredit  this  work, 
the  men  will  slight  it. 

Marching  commands  will  ordinarily  find  the  shallow,  in- 
dividual "straddle  trench"  satisfactory.  A  series  of  these 
is  dug  side  by  side  and  3  feet  apart.  Each  trench  is  3  feet 
long,  1  foot  deep,  and  merely  as  wide  as  the  spade.  A 
man  using  such  a  trench  squats  astride  of  it  and  covers  his 
excreta  with  earth  as  soon  as  they  are  voided  (Fig.  44). 

Washing  of  Hands. — It  is  desirable  that  the  men  should 
be  trained  to  wash  their  hands  after  defecation;  this  pro- 
cedure becomes  necessary  when  intestinal  disease  of  an  in- 
fectious nature  is  present  in  camp.  At  such  times  a  lavatory 
bench  with  a  supply  of  basins,  soap,  water,  and  some  disin- 
fectant solution  should  be  maintained  at  each  latrine. 

15 


226 


MILITARY  HYGIENE 


Disposal  of  Garbage. — Extended  trial  has  been  made  by 
us  of  methods  for  the  disposal  of  garbage,  wet  and  dry. 
Most  of  these  methods  have  involved  removal  in  wagons  or 
carts  to  incinerators  of  various  types  located  at  convenient 
points  in  the  camp  area.  The  incineration  has  been  satis- 
factorily performed,  but  the  "slops"  have  emphasized  their 
character  by  leaving  trails  through  camp,  where  the  cans 
carried  on  escort  wagons  have  spilled  over.  The  necessity 


Fig.  44. — Shallow  "straddle"  trenches  for  excreta. 

for  cans  and  the  attraction  to  flies  in  the  accumulation  of 
garbage  therein  are  other  objectionable  features.  A  system 
has,  therefore,  been  evolved  whereby  each  mess  incinerates 
its  own  garbage  promptly.  This  is  performed  in  pits  pre- 
pared in  the  following  manner:  (a)  Sites  are  selected  close 
to  the  company  kitchen-mess  shelter  and,  preferably,  in  one 
line  for  each  regiment,  (b)  A  pit  is  dug,  approximately  4J 
feet  long,  3  feet  wide,  and  1  foot  deep,  which  is  filled  with 


THE  DISPOSAL  OF  WASTES 


227 


large  rocks.  The  pit  is  purposely  made  shallow,  so  that  the 
rock  lining  may  be  thoroughly  heated.  Deeper  pits  become 
mere  cesspools  unless  the  soil  is  very  porous,  (c)  A  rock  wall, 
1J  feet  high  and  reinforced  with  earth,  is  built  up  around 


Fig.  45. — Company  mess  incinerator  (Straub). 

two  sides  and  one  end  of  the  pit;  the  other  end  is  left  open 
to  assist  the  draft  and  to  facilitate  the  removal  of  ashes. 
Cooks  are  required  to  dispose  of  all  kitchen  wastes  (liquid 
as  well  as  solid)  in  this  incinerator,  and,  as  the  former  is  the 
more  difficult,  they  soon  learn  to  be  economical  in  their  use 


228  MILITARY  HYGIENE 

of  water.  Solids  are  placed  directly  upon  the  fire  and  liquids 
are  carefully  poured  upon  the  heated  rocks  of  the  side  walls. 
About  one-sixth  of  a  cord  of  wood  per  day  is  required  for 
each  incinerator.  If  the  command  has  no  field  ranges,  the 
incinerator  fire  is  well  adapted  for  the  preparation  of  food. 
If  rocks  are  not  available,  a  horseshoe  of  clay  (or  bricks  and 
cement)  may  be  constructed,  to  form  a  sort  of  fire-box  hav- 
ing the  general  dimensions  of  the  rock  pit  described  above. 
The  open  end  is  toward  the  prevailing  wind;  a  Sibley  stove  or 
other  contrivance  is  set  up  for  a  chimney  and  a  large  pan  is 
placed  over  the  top.  Solids  are  burned  on  the  fire  and  liquids 
are  evaporated  from  the  pan.  A  marked  saving  of  fuel  results 
from  this  device. 

Pits  for  Liquid  Garbage. — Liquid  garbage  may  be  dis- 
posed of  in  pits  measuring  about  3  feet  in  the  various  dimen- 
sions. The  soil  must  be  porous  or  the  pits  will  soon  fill  up. 
In  the  latter  case  their  contents  might  be  removed  by  an 
odorless  excavator.  Liquids  poured  into  pits  should  always 
be  screened  through  a  wire  mesh  or  a  piece  of  sacking  and 
the  solid  refuse  burned.  Pits  must  be  covered  to  exclude 
flies.  This  method  is  not  regarded  favorably,  for  the 
reason  that  total  destruction  is  practicable  and  so  much 
preferable. 

Care  of  Cans  and  Stands. — Where  garbage  is  collected  in 
cans,  these  should  be  cared  for  as  in  garrison.  They  are 
to  be  elevated  on  stands  (which  in  the  absence  of  lumber  may 
be  constructed  of  saplings  or  split  cordwood).  Cans  and 
stands  should  be  whitewashed.  The  former  must  be  kept 
covered,  emptied  daily,  and  cleansed  by  rinsing  with  milk 


THE  DISPOSAL  OF  WASTES  229 

of  lime  or  by  burning  out  with  straw,  paper,  or  oil.  If  the 
ground  beneath  the  stands  be  soiled,  lime  solution  is  thrown 
upon  it.  When  the  solids  are  burned  and  the  liquids  other- 
wise disposed  of,  these  two  components  of  the  garbage  must 
be  kept  in  separate  cans. 

Marching  Commands. — With  marching  commands,  gar- 
bage disposal  is  much  simpler.  A  hole  1  or  2  feet  in  diameter 
and  at  least  2  feet  deep  is  dug  near  the  company  kitchen 
and  solids  and  liquids  thrown  therein.  Such  holes  are  care- 
fully filled  in  before  the  march  is  resumed.  In  case  it  is 
anticipated  that  other  troops  will  soon  occupy  the  same  site, 
burial  must  be  deeper  or  the  solids  of  the  garbage  burned  in 
the  kitchen  fire. 

Disposal  of  Manure. — Manure  should  be  removed  daily 
to  the  dumping-ground  or  incinerator.  Picket  lines  should 
be  swept  frequently  and  the  ground  occupied  by  them 
sprinkled  with  crude  oil  occasionally.  If  this  substance 
proves  harmful  to  the  hoofs  of  the  horses,  it  may  be  cov- 
ered over  with  a  little  earth;  or,  the  ground  may  be  burned 
over  with  the  aid  of  straw.  These  measures  are  for  the 
discouragement  of  flies  and  their  breeding.  In  case  the 
manure  at  the  dump  cannot  be  rapidly  burned  by  special 
means,  the  piles  should  be  set  on  fire  and  kept  burning, 
with  the  aid  of  oil  if  necessary.  The  dumping-place  should, 
of  course,  be  to  leeward  of  the  camp.  An  efficient  and  eco- 
nomical device  for  the  incineration  of  manure  is  easily  made 
by  setting  up  a  gridiron  of  old  rails  or  pipes  on  stones  a  foot 
or  so  above  the  ground.  The  manure  is  thrown  on  the  grid 
and  a  fire  started  beneath,  after  which  the  drying  refuse  will 


230 


MILITARY  HYGIENE 


serve  as  fuel  for  its  own  destruction.     The  method  is  thus 
economical  in  fuel  and  tending. 

Camp  Sweepings. — A  surprising  amount  of  rubbish  needs 
removal  from  the  camp  area  each  day.  This  consists  of  waste 
paper,  leaves,  twigs,  grass,  sweepings  from  tents,  old  cloth- 
ing, and  the  like.  A  convenient  method  of  collection  for  the 
bits  of  waste  paper  which  blow  about  a  camp  is  to  furnish 
each  of  several  members  of  the  police  party  with  a  sharpened 
stick  and  a  gunny  sack;  the  paper  is  picked  up  with  the  stick 


Fig.  46. — Circular  pit  (rock  pile)  crematory  (after  Wilson). 

and  the  sack  serves  as  a  place  of  deposit.     Rubbish  is  to  be 
burned,  preferably  in  the  incinerator. 

Circular  Pit  Incinerator.— The  type  of  improvised  field 
incinerator  which  has  been  found  most  useful  in  our  service 
for  general  purposes  is  a  circular  pit.  This  type  is  variously 
known  as  the  pit  crematory,  the  rock  pile  crematory,  or  the 
circular  pit  incinerator.  As  ordinarily  constructed,  a  cir- 
cular pit  having  sloping  sides  is  dug  in  a  suitable  situation. 
A  cone  of  rocks,  whose  apex  is  1  or  2  feet  higher  than  the 
ground  level,  is  next  built  at  the  pit's  center,  to  serve  as  a 


THE  DISPOSAL  OF  WASTES  231 

sort  of  chimney.  The  entire  pit,  bottom  and  sides,  is  then 
lined  with  large  stones.  Finally,  a  ramp  of  logs,  earth,  or 
rocks  is  laid  at  the  margin.  The  dimensions  of  the  pit  are: 
diameter  at  ground  level,  15  feet;  diameter  at  pit  floor,  10 
feet;  depth,  3  feet;  base  of  rock  cone,  3  feet.  The  crematory 
is  operated  in  the  following  manner :  a  fire  of  cordwood  is  built 
in  a  quadrant  of  the  pit  and  is  allowed  to  burn  for  an  hour  or 
more,  until  the  mass  is  thoroughly  ignited  and  the  adjacent 
rock  lining  of  the  pit  is  well  heated.  Solid  wastes  are  then 
carefully  fed  upon  the  fire,  where  they  soon  dry  and  are  con- 
sumed. Liquid  wastes  are  poured  upon  the  heated  stones, 
which  evaporate  them  promptly.  The  next  day  the  fire  is 
started  in  another  quadrant  and  that  used  previously  is 
allowed  to  cool,  when  the  ashes  and  other  incombustible  re- 
fuse are  raked  out  and  removed  to  the  nearby  dump.  This 
crematory  is  wasteful  in  fuel,  but  if  plenty  of  wood  is  avail- 
able, and  caution  is  exercised  not  to  drown  out  the  fire  with 
liquids  carelessly  applied,  it  will  consume  about  two  tons  of 
organic  refuse  per  cord.  The  pit  is  capable  of  incinerating 
dead  animals,  and,  when  well  tended,  may  be  used  for  the 
destruction  of  excreta.  One  attendant  is  necessary  to  build 
the  fire,  feed  the  wastes  properly,  and  keep  the  pit  and  its 
surroundings  in  a  cleanly  state. 

Sod  Crematory. — If  fuel  is  scarce,  another  kind  of  crema- 
tory may  be  improvised,  which  is  efficient  for  a  limited 
amount  of  solids  and  a  less  proportion  of  liquids.  It  con- 
sists of  two  stone-lined  trenches  crossing  one  another  at 
right  angles,  with  a  round  chimney  of  clay  or  sod  over  the 
point  of  intersection.  The  trenches  should  be  about  6  feet 


232 


MILITARY  HYGIENE 


long  and  1J  feet  wide;  their  common  center  is  1  foot  deep, 
but  thence  they  slope  upward  to  the  surface  level.  Their 
purpose  is  to  provide  apertures  for  draft  and  for  the  removal 
of  ashes.  The  chimney  is  to  be  built  about  3  feet  high  (Fig. 


Fig.  47. — Sod  crematory. 

47).  A  strong  fire  is  started  at  the  bottom  of  the  chimney 
and  the  draft  is  regulated  by  closing  up  those  trench  openings 
which  are  out  of  line  with  the  wind.  Solids  are  thrown 
down  the  chimney  directly  upon  the  fire  and  liquids  are 
poured  upon  the  heated  stones  of  the  trench  linings.  If 


THE  DISPOSAL  OF  WASTES  233 

iron  bars  of  any  sort  are  available,  the  efficiency  of  this 
crematory  is  much  increased  by  laying  them  at  the  bottom 
of  the  chimney  as  a  grate.  Several  pieces  of  corrugated  iron, 
bent  round,  wired  together,  and  with  holes  cut  at  the  lower 
edge  for  draft,  will  make  a  crematory  which  operates  simi- 
larly to  the  one  just  described.  Other  types  resemble  a 
bee-hive  or  a  horseshoe  in  form. 

Wash  Water. — Fouled  water  resulting  from  the  washing 
of  the  persons  and  clothing  of  the  men  must  be  adequately 
cared  for  or  it  will  be  thrown  upon  the  ground,  producing 
muddy  areas  which  will  contain  a  considerable  percentage  of 
decomposable  organic  material  that  will  attract  flies  and  may 
give  off  offensive  odors.  The  simplest  way  to  provide  for 
these  waste  liquids  is  to  dig  pits  directly  beneath  the  wash- 
basin benches,  the  laundry  tables,  and  the  bath-house  drains, 
into  which  the  soiled  water  flows  or  is  poured.  If  the  soil 
is  permeable,  the  pits  are  filled  with  stones.  If,  on  the 
other  hand,  the  soil  will  not  permit  the  water  to  drain  away, 
pits  must  not  be  stone-filled,  but  should  be  covered  with 
boards  (or  brush  and  earth)  and  emptied  when  necessary  by 
means  of  the  excavator  pump  and  wagon. 

Waste  from  Taps. — Excess  flow  from  water  taps  is  taken 
up  by  stone-filled  box  frames  sunk  in  the  ground  under  the 
taps.  Overflow  from  watering  troughs  must  likewise  be 
cared  for.  Vigilance  must  be  exercised  to  keep  down  the 
wastage  of  water  to  the  lowest  possible  limit,  so  that  the 
quantity  to  be  disposed  of  shall  not  be  too  great  for  us  to 
handle.  To  this  end,  self-closing  cocks  should  be  placed  on 
the  hydrants,  the  keys  to  taps  over  latrine  troughs  should 


234  MILITARY  HYGIENE 

be  removed  and  troughs  filled  only  by  the  sanitary  squad; 
a  bath-house  orderly  should  be  charged  with  the  duty  of 
keeping  shower  taps  turned  off  when  not  in  use;  and  a 
plumber  is  to  be  employed  to  correct  leaky  fixtures. 

Camp  Drainage. — Camp  areas  may  be  inundated  by  sud- 
den rains;  therefore  company  streets,  picket  lines,  sinks,  in- 
cinerators, arid  (most  important  of  all)  tents,  should  be  pro- 
tected by  a  system  of  ditches.  These  should  be  united  into 
a  well-thought-out  drainage  system,  that  storm  waters  may 
be  carried  away  as  fast  as  they  fall. 


CHAPTER    XIII 
TROPICAL  AND  ARCTIC  SERVICE 

Tropical  Service 

Tropical  Climate. — It  is  popularly  supposed  that  in  chang- 
ing from  a  temperate  to  a  tropical  climate  the  principal 
difference  noted  is  an  increase  of  heat.  This  difference  is 
not  striking,  however,  and,  in  point  of  fact,  there  are  days 
in  our  North  American  summers  which  are  much  hotter 
than  any  noted  in  our  tropics.  92°  in  the  shade  is  hot  for 
the  Philippines,  while  102°  is  not  uncommon  in  some  parts 
of  the  United  States.  But  the  warmth  of  the  climate  is  con- 
tinuous, within  very  moderate  range,  throughout  the  year, 
and  there  is  no  marked  succession  of  seasons  with  relation 
to  temperature.  It  is  this  continuous  high  temperature, 
unrelieved  by  periods  of  cold  and  associated  as  it  is  with  a 
high  degree  of  humidity,  which  proves  so  trying  to  our  people 
and  is  chiefly  responsible  for  the  loss  of  energy,  initiative,  and 
memory,  and,  in  fact,  the  general  physical  and  mental 
deterioration  which  is  frequently  observed  after  two  or  three 
years'  residence.  The  factor  of  atmospheric  moisture  is 
important.  Man  can  bear  high  atmospheric  temperature 
easily  provided  the  air  is  dry,  but  when  that  air  is  charged 
with  moisture,  evaporation  from  the  surface  of  the  body  (so 
necessary  to  the  maintenance  of  the  normal  bodily  tempera- 
ture) is  considerably  diminished.  If,  however,  there  is  a 

235 


236  MILITARY  HYGIENE 

breeze,  high  humidity  (as  well  as  heat)  is  much  more  bearable. 
This  conjunction  of  meteorologic  conditions  exists  in  our 
tropics,  for  at  most  seasons  of  the  year  the  heat  and  moisture 
of  the  atmosphere  are  rendered  more  bearable  by  the  per- 
sistence of  winds.  In  the  Philippines  these  are  known  as 
the  northeast  and  southwest  monsoons.  Another,  atmo- 
spheric factor  which  plays  some  part  in  producing  departures 
from  a  state  of  health  is  tropical  sunlight.  Observers  in 
Manila  have  concluded  that  the  light  rays  proper  are  not 
harmful,  except  for  the  glare  on  sensitive  retinas.  They 
are  further  of  the  opinion  that  the  ultra-violet  (chemical) 
rays  of  the  solar  spectrum  do  no  injury  so  long  as  the  body 
is  covered,  but  that  the  infra-red  (heat)  rays  have  hurtful 
potentialities.  The  theory  that  blondes  are  more  likely 
to  break  down  in  the  tropics  than  brunettes,  by  reason 
of  the  alleged  fact  that  their  skins  are  more  readily  pene- 
trated by  some  of  the  rays  mentioned,  has  not  been  sub- 
stantiated. 

Effects  of  Tropics. — After  a  somewhat  prolonged  exposure 
to  tropical  conditions — say  from  one  year  upward — the 
average  American  experiences  a  certain  loss  of  energy,  initia- 
tive, and  memory.  Many  persons  grow  irritable,  morose, 
and  homesick.  Fits  of  passion  may  be  caused  by  trivial 
incidents.  There  is  often,  at  the  same  time,  an  enfeeble- 
ment  of  constitution  or,  at  least,  a  diminished  power  of  resist- 
ance to  disease.  Individuals  vary  greatly  in  this  regard, 
some  seeming  to  thrive.  It  is  believed  to  be  a  fact,  however, 
that  even  these  are  usually  constitutionally  undermined 
by  prolonged  residence,  so  that,  when  attacked  by  acute 


TROPICAL  AND  ARCTIC  SERVICE  237 

illness,  they  frequently  succumb  with  astonishing  ease. 
Women  are,  as  a  rule,  more  promptly  affected  by  the  climate 
than  men.  Children  born  in  the  tropics  are  usually  fragile, 
and  require  a  sojourn  in  a  colder  climate  to  give  them  a 
reserve  of  strength.  Older  children — of  school  age — do  well 
for  two  or  three  years.  Enlisted  men  have  no  social  oppor- 
tunities, and  furloughs  (involving  a  chance  to  visit  the  home 
or  foreign  lands  for  recuperation),  such  as  may  be  enjoyed 
by  officers,  are  practically  out  of  the  question  for  the 
former. 

Causes  of  Disease. — But  climatic  conditions  by  themselves 
are  perhaps  not  so  much  responsible  for  sickness  as  is  the 
presence  of  many  kinds  of  preventable  disease,  associated 
with  ignorance  and  carelessness;  in  other  words,  defective 
hygiene.  Men  are  apt  to  continue  habits  formed  in  tem- 
perate climes  which  are  unsuitable  for  the  tropics.  It  is 
not  unusual  for  a  vigorous  individual  to  experience  a  sense 
of  exhilaration  during  the  first  few  weeks  of  his  tropical 
service;  this  may  lead  him  into  habits  of  carelessness  or 
excess.  At  the  same  time,  opportunities  for  dissipation 
are  frequent,  while  ordinary  restraints  and  normal  outlets 
for  energies  are  less  than  at  home.  Under  such  circum- 
stances, alcoholic  and  sexual  excesses  are  common.  Later 
on,  a  want  of  buoyancy,  a  weariness  of  mind  and  body,  a 
feeling  of  depression,  may  tend  to  alcoholic  indulgence. 
There  are,  then,  many  factors  contributory  to  disease  in  the 
tropics,  though  but  few  of  these  are  peculiar  to  hot  climates. 
In  addition  to  those  already  cited  (heat,  humidity,  habits, 
idiosyncrasy,  prevalence  of  infectious  diseases),  other  factors 


238  MILITARY  HYGIENE 

may  be  operative.  Such  are:  the  location  of  the  individual 
(city  or  country  life,  remoteness,  isolation);  occupation; 
monotony;  insanitary  surroundings. 

Acclimatization,  that  is,  the  adaptation  of  the  body  proc- 
esses to  the  new  conditions  imposed  by  tropical  residence, 
may  and  does  take  place  in  some  individuals,  but  in  most 
cases  the  deterioration  referred  to  heretofore  is  apparent, 
though  proper  sanitary  and  personal  measures  against  dis- 
ease undoubtedly  diminish  the  tendency  (as  so  splendidly 
shown  in  Panama).  The  consensus  of  medical  opinion  in 
our  army  as  to  the  length  of  tropical  service  is  very  largely 
to  the  effect  that  more  than  two  years  is  likely  to  result  in 
physical  deterioration  in  the  average  man. 

The  individual  measures  to  be  adopted  for  the  prevention 
of  disease  in  the  tropics  are  adaptations  of  the  principles 
laid  down  in  the  chapter  on  Personal  Hygiene.  Certain 
measures  under  this  head  will  be  briefly  discussed. 

Baths. — Since  perspiration  is  excessive,  frequent  baths 
are  a  necessity  for  comfort  as  well  as  cleanliness.  A  bath- 
tub can  seldom  be  found,  but  as  a  shower  is  so  readily  impro- 
vised and  is  more  grateful  anyway,  this  plan  fulfils  all  re- 
quirements. If  nothing  else  is  available,  an  empty  5-gallon 
kerosene  can  is  always  to  be  had,  which,  when  perforated, 
placed  on  a  support  overhead,  and  partly  filled  with  a  bucket 
of  water,  proves  fairly  satisfactory.  The  question  of  the 
source  of  the  bath  water  is  important,  for  the  ordinary  sur- 
face water  in  the  tropics  teems  with  germs,  often  of  a 'dan- 
gerous sort.  In  the  absence  of  an  approved  supply,  rain- 
water can  be  caught  and  utilized  for  a  large  part  of  the  year, 


TROPICAL  AND  ARCTIC  SERVICE  239 

and  in  the  dry  season  the  water  may  easily  be  boiled  and 
cooled. 

Laundry. — The  question  of  laundering  the  body  linen 
is  always  a  serious  one,  for  the  native  method  is  to  stand  in  a 
pool  of  water  or  a  stream,  wet  the  garment  therein,  lay  it  on 
a  flat  rock,  and  pound  it  with  a  club.  This  is  hard  on  buttons, 
but  does  not  harm  the  germs,  and,  as  soap  is  rarely  used,  the 
degree  of  cleanliness  is  problematic.  Wet  linen,  though 
washed  in  clean  water,  may  be  spread  out  to  dry  on  infected 
ground.  The  only  way  to  be  sure  that  the  clothes  are  soaped, 
boiled,  and  otherwise  properly  handled  is  to  provide  the 
facilities  and  have  the  work  done,  under  supervision,  at 
one's  quarters. 

Diet. — Our  Quartermaster  Department  is  generous  in  its 
provision  for  variety  in  staples.  Tropical  fruits  are  readily 
obtainable,  but  fresh  vegetables — other  than  potatoes  and 
onions — are  seldom  to  be  had.  When  obtained  from  local 
sources  they  are  very  apt  to  convey  disease,  since  irrigating 
waters  are  infected,  while  the  oriental  gardener  uses  human 
excrement  as  a  fertilizer.  Therefore,  all  native  vegetables 
should  be  cooked.  The  local  fruits,  handled  by  unclean 
natives,  should  be  plunged  for  an  instant  in  boiling  water 
before  peeling  and  eating.  This  does  not  injure  the  ordi- 
nary thick-skinned  varieties  and  greatly  diminishes  the  risk 
of  disease  from  this  source. 

Abdominal  Congestion. — The  digestive  organs  have  an 
undue  strain  placed  upon  them  in  the  tropics  by  reason  of  a 
tendency  to  chronic  congestion.  Excesses  in  diet  are,  there- 
fore, especially  to  be  avoided,  and  digestive  irregularities 


240  MILITARY  HYGIENE 

(constipation,  diarrhea,  dyspepsia)  should  be  corrected 
promptly.  Beverages  containing  alcohol  are  generally 
undesirable  because  they  increase  congestion;  if  taken  at 
all,  they  should  not  be  used  before  the  evening.  The  en- 
listed men  must  be  instructed  concerning  the  dangers  of 
drinking  "Vino,"  a  native  Philippine  spirit,  crudely  distilled 
from  the  young  tips  of  the  nipa  palm.  This  liquor  contains 
very  poisonous  principles,  which  give  rise  to  sudden  blind- 
ness, acute  mania,  and  other  mental  aberrations. 

Water. — All  sources  of  drinking-water  in  the  tropics 
should  be  presumed  to  be  infected  and  likely  to  transmit 
disease,  unless  proof  to  the  contrary  has  been  established. 
Our  dependence  for  its  purification  must  rest,  in  the  main^ 
upon  boiling,  although  at  certain  stations  it  may  be  possible 
to  obtain  a  supply  which  has  been  rendered  safely  potable 
by  distillation,  or  the  use  of  some  appliance  such  as  the 
Forbes  sterilizer.  The  precautions  mentioned  must  be 
extended  to  include  all  water  used  for  washing  table  and 
kitchen  ware,  for  brushing  the  teeth,  and  for  any  other 
purpose  where  articles  which  we  handle  may  thus  convey 
infection  to  the  mouth.  The  source  of  aerated  waters  should 
be  investigated,  for  serious  errors  have  been  found  in  their 
manufacture. 

Clothing. — The  outer  garments  are,  of  course,  definitely 
fixed  by  the  War  Department,  but  consideration  of  the 
principles  involved  may  be  useful.  Our  interest  in  this 
matter  covers  two  points.  The  first  is  coolness;  the  second, 
protection  from  the  sun's  rays.  White  absorbs  the  least 
heat,  and  is,  therefore,  coolest.  Khaki  intercepts  a  large 


TROPICAL  AND  ARCTIC  SERVICE  241 

portion  of  the  chemical  rays  and  may  be  useful  for  that 
reason.  Olive  drab  has  the  same  advantage,  but  is  dis- 
tinctly warmer  than  khaki.  On  the  other  hand,  it  should 
be  remembered  that  when  the  garments  are  starched  (and 
they  are  commonly  so  worn),  the  normal  cooling  of  the 
body  (by  radiation,  together  with  evaporation  of  the  per- 
spiration) is  interfered  with,  and  heightened  temperature 
results.  The  headgear  should  have  an  airspace  between 
sweatband  and  brim  to  permit  free  circulation  of  air  within 
the  crown.  For  underclothing,  the  preference  of  the  wearer 
may  be  indulged  to  some  extent.  There  is  no  doubt  that 
a  wool  undershirt  is  less  likely  to  permit  rapid  chilling  of 
the  surface  when  overheated,  and  a  garment  of  this  material 
is,  therefore,  to  be  preferred  for  field  service  when  it  is  well 
borne  by  the  skin.  Linen  mesh  and  cotton  mesh  are  worn 
by  many,  and  when  the  circulation  is  active  these  fabrics 
are,  perhaps,  more  comfortable  than  the  wool.  Silk  is 
preferred  by  some  and  is  suitable  for  tropical  wear.  Under- 
wear of  orange-red  color,  designed  to  exclude  the  chemical 
rays  of  the  sun,  has  been  carefully  studied  in  the  Philippines 
and  found  undesirable,  for  the  reason  that  it  is  decidedly 
hotter  than  white,  thus  inviting,  rather  than  repelling, 
disease.  An  important  accessory  garment  is  an  abdominal 
covering  of  wool  to  be  used  during  sleep.  At  this  time 
chilling  of  the  surface  is  especially  likely  to  occur,  and  the 
abdomen  is  most  sensitive  in  this  regard.  Therefore  a 
broad  circular  band  or,  better,  a  small  apron-shaped  flannel 
pad  should  be  worn;  failing  this,  the  corner  of  a  thin  blanket 
should  be  drawn  across  the  abdomen.  These  precautions 

16 


242  «    MILITARY  HYGIENE 

should  be  taken  even  in  the  hottest  weather.  The  most 
important  points  in  this  connection  may  be  summed  up  in 
the  maxim  "Keep  the  head  cool  and  the  abdomen  warm." 

Exercise  is  just  as  necessary  and  beneficial  as  at  home. 
The  sun  does  not  prove  a  deterrent  to  open-air  work,  though 
common  sense  dictates  that  the  midday  hours  should  not 
be  chosen  for  this  purpose. 

Habitations  should  be  constructed  of  heat-repelling 
materials  (preferably  concrete)  and  raised  from  the  ground 
on  piers.  Walls,  inside  and  out,  should  be  of  soft,  non-re- 
flecting color.  Interiors  should  be  shaded  and  cooled  by 
wide  verandas.  Rooms  should  be  large  and  ceilings  high. 
Double  roofs,  with  intervening  air  space  and  ridge  ventila- 
tion, are  desirable.  Windows  and  doors  ought  to  be  made 
mosquito-proof.  In  the  absence  of  this  latter  provision, 
the  use  of  mosquito-bars  on  beds  must  be  enforced.  Neigh- 
boring vegetation  should  be  thinned  out  and  mosquito- 
breeding  areas  controlled.  Other  vermin — rats,  roaches, 
ants,  flies,  bedbugs — must  be  warred  against.  General 
police  must  be  thorough. 

Special  Diseases. — There  are  many  diseases  peculiar  to 
hot  climates,  and  nearly  all  are  due  to  minute  animal  or 
bacterial  parasites.  Other  diseases  (of  which  malaria  is  the 
chief  example)  are  found  in  higher  latitudes,  but  flourish 
more  actively  in  the  tropics.  The  reason  is  simple,  and  lies 
in  the  fact  that  tropical  conditions  of  heat  and  moisture 
are  most  favorable  to  the  growth  and  multiplication  of  the 
parasites  mentioned,  or  to  the  lives  of  their  intermediate 
hosts.  And  by  "intermediate  hosts"  is  meant  that  many 


TROPICAL  AND  ARCTIC  SERVICE  243 

such  parasites  require,  in  addition  to  man,  some  lesser  ani- 
mal in  which  to  complete  the  cycle  of  their  existence.  In 
the  case  of  malaria  the  mosquito  is  necessary;  in  sleeping 
sickness,  a  biting  fly  and  a  crocodile  are  intermediate  hosts; 
the  rat  and  his  attendant  flea  are  the  media  of  transference 
of  bubonic  plague;  a  tick  conveys  relapsing  fever,  and  so  on. 
To  many  of  these  diseases  the  natives  of  the  country  are 
more  or  less  immune,  while  newcomers — particularly  those 
from  temperate  lands — are  especially  liable  to  be  attacked. 
The  native  immunity  results  from  racial  resistance,  which 
is  handed  down  by  inheritance  from  centuries  of  ancestors  in 
whom  a  survival  of  the  fittest  with  respect  to  the  disease  has 
occurred.  Racial  immunity  has  a  notable  example  in  the 
case  of  yellow  fever  among  the  native  Cubans. 

Malaria  is  very  common  and  often  more  serious  in  type 
than  that  encountered  in  this  country.  Every  year  it  is 
responsible  for  a  very  large  proportion  of  all  the  cases  of 
sickness  among  our  people.  Therefore  the  measures  alluded 
to  in  earlier  chapters,  especially  protection  from  the  bites 
of  mosquitoes  and  destruction  of  their  breeding-places,  are 
of  great  importance.  One  of  the  difficulties  which  con- 
fronts us  in  our  efforts  to  reduce  the  incidence  of  malaria  is 
that  a  very  large  percentage — perhaps  one-half — of  the 
natives  of  tropical  countries  are  affected  with  a  chronic  form 
of  this  disease.  Servants,  laborers,  clerks,  etc.,  are  thus 
likely  to  transmit  it.  Mosquitoes  may  breed  in  unusual 
situations,  such  as  bamboo  joints  and  pitcher  plants. 

Intestinal  "Diseases.— Dysentery  is  a  grave  source  of  trouble, 
particularly  in  the  Philippines.  Victims  of  this  affection 


244  MILITARY  HYGIENE 

are  apt  not  to  make  complete  recoveries,  but  even  after 
return  to  the  United  States  may  suffer  for  years  or  die  of 
sharp  acute  attacks  or  some  complication.  The  risk  of 
cholera  exists  because,  as  with  dysentery,  it  is  likely  that 
certain  natives  habitually  harbor  the  germs,  even  in  the 
apparent  absence  of  the  malady.  Intestinal  parasites  other 
than  those  mentioned  are  very  common.  More  than  half 
the  natives  of  the  Philippines  seem  to  be  infected  with 
worms,  great  and  small.  They  occur  very  commonly  in  the 
white  man,  and  are  due  to  the  neglect  of  the  precautions  so 
constantly  insisted  upon  herein,  that  native  vegetables 
must  be  cooked  and  water  sterilized. 

Small-pox  is  very  prevalent  in  tropical  lands,  and  the 
likelihood  of  contact  with  it  is  greater  than  at  home.  It 
behooves  us,  therefore,  to  be  sure  that  we  are  efficiently 
vaccinated. 

Skin  Diseases. — Few  Americans  escape  the  dhobie  itch, 
a  species  of  ringworm  which  attacks  the  groins  and  armpits, 
and  is  believed  to  be  generally  transmitted  through  imper- 
fectly washed  underclothing.  The  name,  in  fact,  is  derived 
from  this  association  of  ideas,  since  "dhobie"  is  a  Hindoo 
term  meaning  "washerman."  Prickly  heat  torments  many 
who  have  a  tendency  to  perspire  excessively.  This  affection 
is  combated  by  frequent  baths,  alkaline  sponging,  and  the 
use  of  talcum  powder. 

Venereal  diseases  are  more  common  and  virulent  than 
they  are  in  higher  latitudes.  It  is  important  that  the  mili- 
tary personnel  shall  be  made  aware  of,  and  kept  alive  to, 
the  dangers  of  illicit  intercourse.  At  the  same  time,  the 


TROPICAL  AND  ARCTIC  SERVICE  245 

measures  of  prophylaxis  and  punishment  provided  for  by 
our  regulations  should  be  enforced. 

Homesickness. — Finally,  there  is  an  affection  due  to  the 
remoteness  of  our  tropical  possessions  from  "home  and 
mother"  and  the  lack  of  social  amusements  to  which  the 
soldier  may  have  been  accustomed.  This  is  nostalgia,  more 
familiar  to  us  as  homesickness,  which  often  becomes  a  very 
real  disability.  Its  indications  must  be  watched  for  among 
the  men  and  steps  taken  to  promote  cheerfulness  and  con- 
tentment. 

Field  Service. — If  war  is  to  be  waged  in  a  hot  climate,  the 
campaign  should  be  planned  for  the  most  favorable  season,  if 
this  is  possible.  It  is  to  be  expected  that  disease  in  war  time 
will  be  largely  in  excess  of  that  incident  to  field  service  in 
temperate  zones.  Care  must,  therefore,  be  taken  to  observe 
march  and  camp  sanitation.  Fatigue  is  to  be  obviated  by 
light  packs  and  frequent  halts.  Marches  should  be  made 
in  the  cooler  parts  of  the  day.  Crowding  is  prevented  and 
ventilation  ensured  by  an  open  order — as  by  using  both  sides 
of  the  road,  leaving  the  middle  clear.  Advantage  is  taken 
of  shade  and  the  water-supply  is  carefully  arranged  for. 
Chilling  is  to  be  guarded  against,  chiefly  because  latent 
malaria  is  made  active  thereby.  Quinin  is  given  daily  as  a 
routine  measure  for  the  prevention  of  malaria,  when  this 
disease  is  to  be  feared. 

When  debilitated  by  climatic  conditions  or  illness,  conva- 
lescence is  apt  to  be  protracted  and  imperfect.  Under  such 
circumstances  it  is  desirable  or  even  necessary  to  have  a 
sojourn  in  some  hill  station  (as  Baguio,  in  Northern  Luzon), 


246  MILITARY  HYGIENE 

or  to  obtain  a  leave  of  absence  and  spend  it  in  a  cooler  clime 
like  North  China,  Japan,  Australia,  or  the  homeland. 
Neurasthenia  and  recurrent  attacks  of  dysentery,  pernicious 
malaria,  or  heatstroke  usually  necessitate  a  prolonged  period 
of  convalescence  in  the  United  States.  Our  experience  in- 
dicates that  removal  to  a  winter  climate  invigorates  those 
returned  from  tropical  service  most  promptly. 

Arctic  Service 

Cold  Climates  Healthy. — Not  so  much  need  be  said  under 
this  head,  for  cold  regions  are  very  salubrious.  Alaska  is  by 
far  the  healthiest  place  in  which  our  troops  are  stationed. 
This  is  probably  due  chiefly  to  the  fact  that  the  germs  re- 
sponsible for  infectious  diseases  exist  with  difficulty  in  a  low 
temperature.  Man  is  able  to  endure  extremes  of  cold  which 
would  be  fatal  to  most  animals,  because  of  his  ability  to 
clothe  himself  adequately  and  to  produce  shelter  and  fire 
when  needful.  Moderate  cold  is  exhilarating,  and  even  great 
cold  is  well  borne  wlien  vigorous  men  are  prepared  for  it. 
When  such  cold  is  "dry"  and  still,  a  much  lower  temperature 
may  be  endured  than  when  the  atmosphere  is  humid  or  in 
active  motion.  It  is  in  "blizzards"  that  men  are  usually 
overcome  by  the  effects  of  cold. 

Effects. — Exposure  may  result  in  varying  degrees  of  injury 
to  the  body,  from  temporary  discomfort  to  death.  Chil- 
blains, with  their  puffy,  purplish  appearance  and  tingling, 
burning  sensation  (all  of  which  are  aggravated  by  heat),  may 
recur  at  intervals  for  years.  Frost-bite  at  times  necessitates 
amputation  of  the  extremities.  When  a  man  begins  to  freeze, 


TROPICAL  AND  ARCTIC  SERVICE  247 

his  vision  is  dimmed,  his  body  feels  numb,  he  staggers  along 
like  a  drunken  man,  and  he  experiences  an  overpowering 
desire  to  sleep.  To  restore  a  frozen  part,  it  is  important 
that  the  circulation  be  brought  back  gradually.  If  warmth 
is  applied,  reaction  is  excessive  and  the  part  may  mortify. 
Rubbing  with  the  hand,  a  piece  of  fur  or  wool,  or  with  cold 
water  (while  the  victim  remains  in  the  open  air)  until  the 
normal  color  returns,  is  the  appropriate  treatment.  It  is  a 
fallacy  to  use  ice  or  snow  for  this  purpose.  Freezing  occurs 
most  readily  when  the  parts  are  wet,  as  the  loss  of  heat 
from  the  surface  of  the  body  is  rendered  more  rapid  thereby. 
A  minor  form  of  disability  is  that  known  in  Alaska  as  the 
chechawker  (tenderfoot)  knee,  which  is  a  name  applied  to 
pain  and  stiffness  of  that  joint  resulting  from  exposure  to  a 
cold  wind.  Snow-blindness  is  a  distressing  condition,  due 
to  the  effect  on  the  eyes  of  the  sun;s  reflection  from  snow 
surfaces.  It  may  be  prevented  by  wearing  amber-colored 
or  smoked  glasses  or  blinders  of  horsehair  or  wood.  The 
glare  is  mitigated  by  blackening  the  eyelids  with  a  mixture 
of  charcoal  and  grease.  Men  cooped  together  during  the 
long  winters,  with  no  sunlight,  insufficient  exercise,  over- 
crowding, monotony,  and  probable  uncleanliness  show  signs 
of  nervous  strain,  such  as  irritability  and  quarrelsomeness. 
Scurvy  must  be  guarded  against.  If,  under  the  conditions 
cited,  some  of  the  men  begin  to  complain  of  muscular  stiff- 
ness, rheumatism,  night-blindness,  or  sore  gums,  the  com- 
pany mess  should  be  carefully  investigated. 

Food. — The  quantity  of  food   consumed   is  considerably 
greater  than  in  lower  latitudes,  as  much  fuel  must  be  utilized 


248  MILITARY  HYGIENE 

in  keeping  up  the  bodily  fires.  An  approximation  to  the 
character  of  the  native  diet  (in  which  a  large  excess  of  fats 
is  the  distinctive  feature)  is  desirable.  The  use  of  alcohol 
is  more  deleterious  here  than  elsewhere  on  account  of  the 
lowering  of  body  temperature  produced  by  this  substance. 
The  eating  of  snow  to  allay  thirst  causes  stomach  irritation. 
In  field  service  the  use  of  fireless  cookers,  oil  or  alcohol  stoves, 
and  "Thermos"  bottles  will  be  found  of  great  value. 

Clothing. — The  practical  point  about  clothing  is,  not  that 
a  large  amount  shall  be  habitually  worn,  but  that  additional 
external  garments  may  be  readily  donned  or  doffed  as  occa- 
sion requires.  The  Quartermaster  Corps  supplies  a  number 
of  special  articles  for  Alaskan  service.  These  include  Macki- 
naw coats,  pea-jackets,  trousers  lined  with  kersey  or  blanket- 
ing, felt  shoes,  German  socks,  fleece-lined  drawers  and 
undershirts,  fur  caps,  moccasins,  and  mittens  of  fur  or  buck- 
skin. An  excellent  garment,  not  officially  supplied,  is  the 
so-called  parka.  This  is* a  loose  coat  of  canvas  or  drill, 
which  excludes  the  wind ;  it  has  a  fur-edged  hood  and  should 
be  long  enough  to  fall  below  the  knees.  German  socks  worn 
with  moccasins  are  perhaps  the  most  comfortable  footwear 
in  very  cold  weather.  Felt  shoes  are  more  durable,  but  are 
big  and  clumsy.  The  objection  to  all  these  is  that  they  do 
not  exclude  moisture.  Leather  shoes  stiffen  and  rub  the 
feet,  while  they  slip  on  frozen  surfaces.  The  best  covering 
for  the  hands  is  a  woolen  glove  worn  inside  of  a  large,  fleece- 
lined  mitten  of  fur.  Mittens  should  have  the  index-finger 
separated  (as  well  as  the  thumb) ,  in  order  that  the  rifle  may 
be  handled,  and  should  be  insured  against  loss  by  attaching 


TROPICAL  AND  ARCTIC  SERVICE  249 

them  to  a  cord  which  passes  through  the  coat  sleeves  and 
across  the  shoulders.  When  men  are  housed  under  canvas, 
the  tents  should  be  sheltered  by  wind  breaks  of  brush  or 
snow.  Steel  tent  pins,  or  crowbars  to  prepare  holes  for 
wooden  pins,  are  necessary.  For  bedding,  the  sleeping  bag 
of  canvas,  lined  with  blanket  or  sheepskin,  is  highly  valued. 
This  article  should  be  laced  or  buckled,  so  that  it  may  be 
readily  taken  apart  for  cleansing  and  drying  or  to  remove  the 
blankets. 

Disposal  of  Refuse.— Organic  refuse  should  be  deposited 
at  designated  places.  During  the  winter  these  substances 
are  rendered  innocuous  by  freezing.  On  the  approach  of 
spring  the  frozen  masses  should  be  removed  and  properly 
disposed  of. 

Personal  hygiene  is  of  much  importance.  The  men  should 
be  well  instructed  in  measures  for  taking  care  of  themselves. 
In  permanent  stations  there  should  be  facilities  for  bathing; 
the  Russian  bath,  with  its  steam  and  hot-air  rooms  and  cold 
shower,  is  much  appreciated.  Systematic  exercise  is  neces- 
sary. Measures  of  general  interest,  such  as  games,  hunting 
parties,  and  entertainments,  must  be  instituted  to  overcome 
monotony.  Bedbugs  and  lice  find  favorable  conditions  in 
Arctic  life  and  must  be  vigorously  combated.  Unnecessary 
exposure  is  to  be  minimized;  when,  for  instance,  a  storm 
makes  exposure  particularly  severe,  sentries  should  be 
changed  every  half-hour  or  so. 


CHAPTER    XIV 
VENEREAL  DISEASES 

Importance  of  the  Subject. — A  special  chapter  is  given  to 
this  subject  because  of  its  great  and  growing  importance. 
The  American  people  have,  until  recently,  shunned  public 
discussion  of  venereal  matters  through  what  many  now  feel 
to  have  been  mistaken  prudery.  A  great  movement  has 
lately  been  instituted,  through  the  American  Association  for 
Sex  Hygiene  and  allied  societies,'  looking  to  the  awakening 
of  the  public  conscience  and  the  moral  education  of  the  youth 
of  the  land. 

Prevalence  in  the  Army. — Venereal  infections  are  respon- 
sible for  an  enormous  amount  of  sickness  in  the  army— 
vastly  more  than  any  other  cause — and  constitute  the 
most  important  health  problem  with  which  we  have  to  deal. 
There  are  constantly  on  the  sick  report  from  this  cause  a 
number  of  men  which  more  than  equals  the  strength  of  a 
regiment  of  infantry.  Our  army  has  the  unenviable  dis- 
tinction of  having  a  much  greater  amount  of  sickness  of  this 
nature  than  any  foreign  army.  Moreover,  since  the  Spanish- 
American  War  the  ratio  of  such  cases  has  rapidly  increased, 
until  it  is  now  twice  as  much  as  in  1898.  The  situation 
must,  therefore,  be  fairly  faced  and  every  effort  put  forth  to 
determine  the  causes  for  the  prevalence  of  venereal  diseases 
and  to  devise  measures  for  their  prevention. 

250 


VENEREAL  DISEASES  251 

That  the  army  has  a  greater  percentage  of  such  disease 
than  has  an  equal  number  of  vigorous  young  unmarried  men 
drawn  from  like  source  in  civil  life  is  not  believed.  Such  in- 
fections cause  the  largest  proportion  of  rejections  of  ap- 
plicants for  enlistment.  They  honeycomb  our  social  struc- 
ture. In  point  of  prevalence  they  vastly  outnumber  all 
other  infectious  diseases,  both  acute  and  chronic,  combined. 

Causes. — These  are  not  far  to  seek.  In  the  first  place, 
sexual  desire  is  implanted  in  man  as  a  compelling  factor 
for  the  perpetuation  of  the  race.  This  desire  is  strong, 
especially  when,  by  previous  exercise  of  the  function,  the 
habit  has  been  formed.  Next,  the  demand  for  partners  in 
the  sexual  relation  has  always  created  a  supply,  and  pros- 
titution is  as  ancient  as  history.  Of  late  this  supply  has 
been  elevated  to  the  dignity  (?)  of  a  business,  and  a  hideous 
traffic,  with  an  intricate  system  for  procuring  young  girls 
and  suborning  those  who  legally  should  prevent  such  traffic, 
is  now  strongly  entrenched. 

Preventive  Measures. — How,  then,  shall  we  set  about  to 
minimize,  as  far  as  possible,  the  incidence  and  effects  of  these 
loathsome  diseases,  largely  dependent,  as  they  are,  upon 
causes  inherent  in  the  nature  of  mankind?  From  a  sani- 
tary standpoint  it  is  plain  that  we  must  apply  the  ordinary 
principles  of  sanitation.  That  is,  we  must  recognize  their 
contagious  character  and  apply  such  preventive  measures 
as  are  effective  in  other  transmissible  diseases.  The  most 
important  measure  of  this  character  is  the  isolation  of  infected 
individuals  until  the  danger  of  transmission  is  past.  In  the 
army  we  can  and  do  control  our  infected  soldiers,  but  the 


252  MILITARY  HYGIENE 

women  from  whom  their  disabilities  were  derived,  as  well  as 
infected  male  civilians,  are  still  at  large  to  spread  the  con- 
tagion further.  It  is  obvious,  therefore,  that,  if  we  hope  for 
success,  sentimentalism  and  prudery  must  give  way,  and  that 
diseased  public  women  must  be  admitted  to  hospitals  or 
otherwise  placed  under  restraint  till  the  infectious  stage  of 
the  disease  is  over.  For  the  diseased  male,  it  should  be  made 
a  crime  knowingly  to  spread  a  venereal  disease. 

Education. — The  measures  above  outlined  do  not  conform 
with  the  yet  uneducated  public  feeling  that  it  is  immoral 
openly  to  recognize  diseases  of  this  class  and  their  chief 
transmitter,  the  prostitute.  On  the  other  hand,  the  meas- 
ures themselves  are  certainly  not  immoral,  while  they  are 
practical.  On  the  moral  side,  the  campaign  of  education 
already  begun  should  be  extended  and  a  flood  of  light  poured 
upon  the  subject,  that  all  may  clearly  understand  sex  mat- 
ters, the  dangers  as  well  as  the  immorality  of  illicit  inter- 
course and  the  methods  of  spread  of  diseases  transmitted 
thereby.  With  such  education,  the  veil  of  ignorance,  mis- 
information, and  prudery  will  be  lifted  and  the  tendency  to 
secret  vices  among  children  will  be  lessened.  Havard  says 
truly,  "It  is  in  the  conscience  of  the  young  man  that  prophy- 
laxis should  begin."  The  knowledge  of  sexual  matters  ac- 
quired by  a  child  is  from  bad  sources  and  of  a  perverted  kind. 
Such  knowledge,  secretly  acquired  and  brooded  over  in  secret, 
hastens  the  awakening  of  sexual  feeling  and  leads  to  vice. 

Action  by  the  War  Department. — Our  War  Department 
has  acted  with  courage  and  vigor  in  attacking  this  problem. 
Orders  were  issued  in  1912  directing  procedures  as  follows: 


VENEREAL  DISEASES  253 

I.  That  physical  inspections  of  enlisted  men  should  be 
made  twice  in  each  month  for  the  detection  of  venereal 
disease. 

II.  That  any   soldier  who  exposes  himself  to  infection 
shall  report  for  cleansing  and  preventive  treatment  imme- 
diately upon  return  to  camp  or  garrison. 

III.  That  any  soldier  who  fails  to  so  report,  if  found  to 
be  suffering  from  a  venereal  infection,  shall  be  brought  to 
trial  by  court  martial  for  neglect  of  duty. 

IV.  That  men  so  diseased  shall  be  confined  strictly  to  the 
limits  of  the  post  during  the  infectious  stages  of  the  disease. 

V.  That  all  officers  serving  with  troops  shall  do  their  ut- 
most to  encourage  healthful  exercises  and  physical  recreation, 
and  to  supply  opportunities  for  cleanly  social  and  interest- 
ing mental  occupations  for  the  men  under  their  command. 

VI.  That  company  and  medical  officers  shall  take  ad- 
vantage of  favorable  opportunities  to  point  out  the  misery 
and  disaster  which  follow  upon  moral  uncleanliness  and  the 
fact  that  venereal  disease  is  never  a  trivial  affair. 

Action  by  Congress. — Congress,  too,  has  taken  a  decided 
stand,  by  an  enactment  providing  that  no  officer  or  enlisted 
man  who  shall  be  absent  from  duty  on  account  of  disease 
resulting  from  his  own  intemperate  use  of  drugs,  or  alco- 
holic liquors,  or  other  misconduct,  shall  receive  pay  for  the 
period  of  such  absence. 

It  will  be  seen  from  the  foregoing  that  the  army  now  has 
an  excellent  plan  for  the  discouragement  of  vice  and  the 
control  of  disease  resulting  therefrom.  To  add  to  the 
effectiveness  of  this  plan,  efforts  are  being  made  to  induce 


254  MILITARY  HYGIENE 

Congress  to  repeal  the  anti-canteen  legislation,  thus  again 
permitting  the  sale  of  beer  and  light  wines  in  the  soldiers' 
clubs  and  co-operative  stores  officially  known  as  post  ex- 
changes. It  is  not  here  argued  that  the  canteen  is  an 
unmixed  good  nor  that  drinking  should  be  encouraged.  It 
is,  however,  in  the  highest  degree  desirable  to  keep  the  men 
away  from  more  evil  influences,  and  it  is  notorious  that  the 
saloon,  prostitution,  and  professional  gambling  go  hand  in 
hand.  The  close  relation  between  alcoholic  excess  and 
sexual  indulgence  is  an  interesting  fact.  A  man's  passions 
are  inflamed  by  liquor,  his  will  power  and  his  judgment  are 
alike  weakened,  and  he  yields  to  conditions  which  in  his 
sober  moments  might  be  positively  offensive  to  him. 

Syphilis. — There  are  three  kinds  of  venereal  disease. 
The  most  serious  to  man  is,  perhaps,  syphilis  (sometimes 
called  the  "pox,"  and  referred  to  in  the  newspaper  adver- 
tisements of  charlatans  as  "blood  disease").  This  is  due 
to  a  very  active,  corkscrew-shaped  protozoal  germ.  Its 
first  apparent  result  is  an  open  sore  at  the  point  of  infection. 
This  sore,  known  as  a  hard  chancre,  does  not  appear  for 
several  weeks  after  exposure,  but  is  then  very  resistant  to 
treatment  and  remains  for  a  month  or  more.  The  body 
is  soon  infected  throughout,  and  symptoms  of  this  condition 
appear  most  often  in  the  form  of  skin  eruptions  and  gland- 
ular swellings. 

Syphilis  is  an  infection  of  the  entire  system  and  its  mani- 
festations are  practically  innumerable.  We  may  expect  it 
to  appear  in  any  conceivable  form,  and  where  a  chronic  case 
of  disease  is  obscure,  tests  often  reveal  its  presence.  Certain 


VENEREAL  DISEASES  255 

of  these  manifestation  may  (and  do)  appear  many  years 
after  the  disease  was  contracted.  Among  these  are  paresis 
(softening  of  the  brain)  and  locomotor  ataxia. 

Syphilis  is  extremely  difficult  to  cure,  and,  in  a  certain 
proportion  of  cases,  never  is  cured.  The  new  remedy— 
"606"  or  salvarsan — is  still  in  the  experimental  stage,  but 
it  is  at  least  certain  that  its  use  is  not  followed  by  permanent 
recovery,  and  that  the  older  and  more  prolonged  forms  of 
treatment  must  still  be  employed.  Syphilis  is  the  disease 
which  is  so  often  transmitted  to  the  children — "even  unto 
the  third  and  fourth  generation,"  as  the  Good  Book  informs 
us — as  well  as  to  the  wife.  It  may  be  transmitted  to  others 
not  only  by  sexual  contact,  but  also  by  means  of  articles 
(such  as  towels,  eating  and  drinking  utensils,  a  comrade's 
pipe)  used  in  common.  Cases  also  are  frequently  met  which 
have  been  innocently  acquired  through  kissing,  surgical  or 
dental  operations,  the  ministrations  of  a  nurse,  and  numer- 
ous other  blameless  ways. 

The  danger  of  transmission  of  the  disease  from  father  to 
child  (hereditary  syphilis)  is  very  considerable.  Many  chil- 
dren are  born  dead;  others  die  soon  after  birth;  still  others 
(who,  though  diseased,  may  survive)  show  characteristic 
deformities  or  unmistakable  syphilitic  lesions. 

Marriage. — "Marriage  of  a  syphilitic  is  permissible  only 
after  five  years,  during  the  last  two  of  which  he  has  been  with- 
out symptoms  and  without  treatment"  (Keyes). 

Gonorrhea,  or  "clap,"  is  the  result  of  infection  with  the 
bacterial  germ  known  as  the  gonococcus,  and  is  characterized 
by  a  profuse  purulent  discharge  from  the  affected  part. 


256  MILITARY  HYGIENE 

This  is  usually  the  canal  of  the  penis  (the  urethra)  in  the 
male,  although  any  mucous  or  serous  membrane  may  be 
involved.  Thus  if,  by  carelessness  or  misfortune,  a  little 
of  the  pus  is  transferred  to  the  eye,  a  most  violent  inflam- 
mation ensues  and  the  sight  is  in  grave  danger  of  destruction. 
Gonorrheal  rheumatism  is  a  common  and  intractable  affec- 
tion. Heart  disease  is  an  occasional  sequel. 

Gonorrhea  is  even  more  frequently  conveyed  to  the  wife 
than  syphilis,  and  with  most  serious  results,  as  thousands 
of  deaths  and  tens  of  thousands  of  chronic  invalids  attest; 
60  to  80  per  cent,  of  pelvic  suppurations  in  women  are  due 
to  this  affection.  The  eyes  of  babies  become  infected  during 
birth.  It  is  estimated  that  25  per  cent,  of  blind  people 
owe  their  infirmity  to  this  cause. 

Gonorrhea  is  popularly  regarded  as  something  of  a  joke, 
an  affection  but  little  more  harmful  than  a  cold  in  the  head; 
but  many  surgeons  look  upon  it  as  more  serious  than  syphilis 
in  its  results,  for  the  infection  has  a  way  of  traveling  along 
the  various  routes  to  the  bladder,  kidneys,  and  testicles, 
leaving  a  man  permanently  injured  and  often  greatly  short- 
ening his  life.  Gonorrhea  is  transmitted  to  innocent  people 
— wife,  child,  comrade — with  extreme  ease,  so,  if  thus  affected, 
one  cannot  be  too  careful  to  make  sure  that  none  of  the 
discharge  is  brought  in  contact  with  a  healthy  individual. 
Cotton  or  other  material  soiled  with  the  discharge  should 
be  burned  or  otherwise  safely  disposed  of. 

Chancroid. — The  third  venereal  disease — chancroid  or 
soft  chancre — is  a  contagious  ulcer.  It  is  always  local,  never 
constitutional,  and  has  no  relation  to  syphilis  (although  it  is 


VENEREAL  DISEASES  257 

frequently  necessary  to  wait  for  weeks  before  one  can  be 
sure  it  is  not  the  latter).  Its  cause  is  a  special  bacillus. 
While  it  may  occur  elsewhere,  it  is  practically  always  found 
about  the  genitals.  Though  less  serious  than  the  other 
diseases  of  this  class,  it  is  a  painful  and  repulsive  affection. 
In  about  one-third  of  the  cases  it  is  accompanied  by  an 
abscess  in  the  groin  known  as  a  bubo. 

Personal  Prophylaxis. — Reference  has  been  made  earlier 
in  this  chapter  to  the  War  Department  requirement  that 
enlisted  men  who  have  exposed  themselves  to  venereal  in- 
fection shall  report  at  hospital  or  dispensary  for  cleansing 
and  preventive  treatment  immediately  upon  return  to  camp 
or  garrison.  It  is  not  necessary  nor  proper  to  enter  here 
into  the  details  of  such  treatment,  but  it  may  be  said  that 
the  procedures  used  are  very  successful  in  the  prevention  of 
infection.  Objection  has  been  made  that  such  prevention, 
by  making  licentiousness  safe,  encourages  the  latter.  As 
already  shown,  our  problem  is  to  keep  our  soldiers  physically 
fit,  and  purely  sentimental  considerations  are  of  secondary 
importance.  Moreover,  our  navy  has  given  the  system  a 
fair  trial,  and  finds  an  actual  diminution  in  percentage  of 
exposures  as  the  result  of  the  campaign  of  education. 

In  the  absence  of  legitimate  intercourse  (that  is,  married 
life),  nature  will  relieve  the  situation  by  an  occasional  noc- 
turnal emission,  which  is  in  no  sense  harmful.  The  culti- 
vation of  pure  thoughts,  the  avoidance  of  temptation,  cold 
baths,  simple,  non-stimulating  diet,  vigorous  physical  exer- 
cise, and  alcoholic  abstinence  will  prove  efficacious  in  over- 
coming desire. 

17 


CHAPTER    XV 

ALCOHOL  AND  OTHER  NARCOTICS 
The  Nature  of  Alcohol 

ALCOHOL  is  the  generic  name  for  a  class  of  chemical  com- 
pounds which  are  formed  from  hydrocarbons  by  the  replace- 
ment of  one  or  more  hydrogen  atoms  by  hydroxyl  (OH). 
When,  however,  the  term  is  used  without  qualification,  it  re- 
fers to  ethyl  alcohol,  whose  formula  is  C2H6O  (CH3,  CH2,  OH). 
This  substance  is  not  found  in  nature  in  a  free  state,  but 
commercially  is  derived  from  the  spirituous  fermentation 
of  saccharine  juices.  The  air-borne  microscopic  fungus 
known  as  the  yeast  plant  produces  a  ferment  which,  acting 
on  sugars,  splits  them  up  into  carbon  dioxid  and  alcohol. 
Such  sugars  are  found  in  nature  in  many  substances,  notably 
in  certain  grains  and  tubers. 

Strength. — The  alcoholic  strength  of  fermented  sugar  solu- 
tions is  never  over  14  per  cent.,  for  the  reason  that  above 
this  point  yeast  ceases  to  act,  but  by  successive  condensa- 
tions and  vaporizations  an  alcoholic  content  of  91  per  cent, 
may  be  had,  and  this  is  the  strength  of  the  commercial  prod- 
uct. By  further  treatment  of  this  substance  with  charcoal 
and  then  rectifying  it  in  a  special  still  over  some  dehydrating 
agent,  the  so-called  absolute  alcohol — which  contains  not 
more  than  1  per  cent,  of  water — is  obtained. 

258 


ALCOHOL  AND  OTHER  NARCOTICS  259 

Physical  Properties. — Alcohol  is  a  colorless  liquid  which  is 
highly  inflammable,  has  a  strong  affinity  for  water,  and 
congeals  at  a  very  low  temperature  (about  200°  F.  below 
zero) . 

Ethyl  alcohol  is  the  essential  principle  of  all  intoxicating 
drinks.  While  alcohol  itself  is  sometimes  employed  in 
diluted  form  as  such  a  drink,  it  is  commonly  taken  in  the 
more  agreeably  flavored  preparations  made  for  man's  con- 
sumption. 

Classification. — These  preparations  are  classified  as  fol- 
lows: 

1.  Wines. 

2.  Malt  liquors. 

3.  Distilled  liquors. 

4.  Patent  medicines — tonics,  bitters,  nerve  stimulants,  etc. 

1.  Wines,   properly  speaking,  consist  of  the  fermented 
juices  of  the  grape,  but  substances  called  wines  are  often 
made  by  the  addition  to  alcohol  of  materials  to  make  the 
product  resemble  the  genuine  article.     Wines  have  an  alco- 
holic content  of  9  to  22  per  cent.,  the  stronger  ones  being 
"fortified"  by  the  addition  of  an  extra  amount  of  alcohol. 
Home-made  wines — hard  cider,  currant  wine,  and  the  like — 
contain  5  to  10  per  cent,  of  alcohol. 

2.  Malt   liquors   are   produced    by  the    fermentation  of 
malted  grain,  to  which  a  bitter  substance — usually  hops — 
is   added  to   impart  the   characteristic  flavor.     Beer,   ale, 
and  porter  are  the  most  commonly  used  beverages  of  this 
class.     These  contain  2|  to  8  per  cent,  of  alcohol.     One 
pint  of  beer  has  about  1  ounce  of  alcohol.     Beer  prepared 


260  MILITARY  HYGIENE 

for  export  is  frequently  adulterated  with  salicylic  acid  to 
ensure  its  keeping  qualities.  This  substance  is  objection- 
able because  it  interferes  with  digestion. 

3.  Distilled  liquors,  or  spirits,  as  the  name  implies,  result 
from  the  distillation  of  saccharine  or  starchy  substances. 
Besides  ethyl  alcohol,  spirits  contain  small  quantities  of  the 
higher  alcohols  (propyl,  butyl,  amyl)  as  well  as  other  aromatic 
principles,  to  whose  derivatives  the  flavor  of  old  whiskies 
and  brandies  is  due.  These  are  highly  poisonous,  but  are 
present  in  amounts  so  minute  as  to  be  negligible  toxicologic- 
ally.  We  may,  therefore,  consider  that  the  effects  of  liquors 
are  in  direct  proportion  to  their  content  of  ethyl  alcohol. 

Liquors  occur  in  the  following  forms: 

(a)  Brandy. 

(6)  Whisky. 

(c)  Gin. 

(d)  Rum. 

(e)  Liqueurs. 
(/)  Vino. 

(a)  Brandy  is  distilled  from  grapes  and  fruit  and  has  a 
high  alcoholic  percentage  (50  to  56  per  cent.). 

(b)  Whisky  is  the  spirit    most    commonly  used  in  this 
country.     Various  forms  of  this  beverage  are  distilled  from 
different  substances;  for  example,  Bourbon  whisky  is  made 
from  corn;  Scotch  whisky,  from  barley;  Irish  whisky,  from 
potatoes;  rye,  from  the  grain  of  that  name;  while  baser  grades 
are  produced  from  oats,  beets,  refuse  molasses,  and  even  saw- 
dust.    So-called  "blended"  whisky  is  merely  a  mixture  of 
a  "straight"  whisky  with  varying  proportions  of  alcohol,  and, 


ALCOHOL  AND  OTHER  NARCOTICS  261 

finally,  whisky  may  legally  be  made  by  the  addition  to  alco- 
hol of  coloring-matter  and  flavoring  agents.  Doctor  Wylie 
reports  that  "85  per  cent,  of  whisky  sold  in  this  country  is 
nothing  less  than  a  cheap  imitation."  Many  adulterants 
are  employed  and  much  whisky  is  made  from  refuse  sub- 
stances. However,  such  adulterants  are  not  usually  harm- 
ful and  consist  most  often  of  caramel  and  water.  Whisky 
has  about  50  per  cent,  of  alcohol  in  its  composition. 

(c)  Gin  is  made  in  the  same  manner  and  from  the  same 
materials  as  whisky,  with  the  exception  that  juniper  berries 
are  added  as  a  flavoring  agent.     It  is  popularly  supposed 
to  exert  a  favorable  influence  upon  the  action  of  the  kidneys, 
but  it  is  highly  probable  that  this  liquor  has  done  more 
harm  than  good  to  the  organs  mentioned.     Gin  contains 
40  to  50  per  cent,  of  alcohol. 

(d)  Rum  is  derived  from  molasses,  and  has  an  even  higher 
alcoholic   content   than   the   spirits   heretofore   mentioned, 
namely,  60  per  cent. 

(e)  Liqueurs  are  sweetened  spirits,  flavored  with  some 
aromatic  substance.     Absinthe,  benedictine,  and  chartreuse 
are  examples  of  this  class.     Absinthe  contains  70  to  80  per 
cent,  of  alcohol,  and  its  use  is  believed  to  lead  to  evil  effects 
out  of  proportion  even  to  this  great  percentage. 

Cordials  are  liqueurs  prepared  with  fresh  fruit  juices. 

(/)  Vino  is  a  crudely  distilled  spirit  made  in  the  Philip- 
pines from  the  young  shoots  of  the  nipa  palm.  It  is  potent 
for  evil,  as  it  contains  a  large  amount  of  methyl  alcohol. 
Indulgence  by  Americans  has  frequently  resulted  in  blind- 
ness or  acute  insanitv. 


262  MILITARY  HYGIENE 

4.  Patent  Medicines  Containing  Alcohol. — Since  some  of 
these  have  been  known  as  "temperance  drinks"  (at  least 
prior  to  the  enforcement  of  the  Food  and  Drugs  Act),  large 
quantities  are  sold  to  people  ignorant  of  the  fact  that  they 
are  alcoholic  beverages.  Many  such  alleged  medicines  con- 
tain a  greater  percentage  of  alcohol  than  ordinary  wine  and 
beer.  They  seem  to  be  popular  in  proportion  to  their  alco- 
holic content,  and  have  undoubtedly  been  responsible  for 
the  formation  of  the  habit  in  many  persons.  A  few  of  those 
most  advertised  are  named  below,  with  a  statement  of  their 
alcoholic  percentages: 

Per  cent. 

Greene's  Nervura 17 

Paine's  Celery  Compound 21 

Ayer's  Sarsaparilla 26 

Peruna 28 

Warner's  Safe  Tonic  Bitters 35 

Hostetter's  Stomach  Bitters 44 

"Denatured"  alcohol  is  the  ordinary  product,  to  which 
methyl  alcohol  and  benzine  or  naphtha  have  been  added  in 
order  to  render  it  undrinkable.  It  is  used  in  the  arts  and 
manufactures. 

Wood  Alcohol. — Methyl  (wood)  alcohol  is  capable  of  pro- 
ducing intoxication  and  is  sometimes  employed  for  that 
purpose.  Such  use  must  be  unqualifiedly  condemned,  for 
wood  alcohol  is  highly  poisonous  and  has  frequently  caused 
mania,  blindness,  or  death  after  a  single  indulgence. 

The  Effects  of  Alcohol  on  the  Tissues  and  Vital  Processes  of  the 
Human  Body 

On  the  Cells. — The  human  body,  like  other  complex  living 
organisms,  is  made  up  of  units  which  we  term  cells.  The 


ALCOHOL  AND  OTHER  NARCOTICS  263 

substance  composing  the  cells  is  called  protoplasm.  Perhaps 
the  most  common  and  characteristic  action  of  alcohol  on 
the  body  is  its  eft'ect  upon  the  cells  thereof,  particularly 
those  of  the  nervous  system.  Alcohol  is  a  protoplasmic 
poison,  in  that  it  inhibits  the  activity  of  the  individual  cell, 
especially  by  interfering  with  its  capacity  for  taking  up  oxy- 
gen— what  may  be  called  the  "breathing  function"  of  the 
cell.  Changes  in  nerve-cells  may  be  recognized  after  a 
single  indulgence,  though  such  changes  disappear  rapidly 
and  completely  if  no  more  alcohol  be  taken.  Continued 
overuse  results  in  chronic  degeneration  of  nerve-cells,  with 
an  increase  in  the  intercellular  connective  tissue. 

On  the  Nervous  System. — Alcohol  exerts  a  specific  action 
on  nerve-centers.  The  special  affinity  possessed  by  the 
nervous  system  for  this  drug  is  shown  by  the  fact  that  when 
all  traces  of  its  use  have  disappeared  elsewhere,  it  can  still 
be  detected  in  the  cerebrospinal  fluid.  Curiously  enough, 
the  highest  and  last-formed  faculties  of  the  brain — namely, 
the  consciousness  of  right  and  wrong,  ethical  conceptions  of 
duty  and  responsibility,  reasoning  power,  memory,  judgment, 
self-control,  will,  and  the  sense  of  proportion — are  the  first 
to  feel  the  narcotic  action  of  the  drug.  While  this  is  occur- 
ring the  individual  is  apt  to  be  deceived  into  thinking  that 
all  the  above  qualities  are  quickened;  that  he  is  witty  and 
giving  pleasure  to  others  by  his  fluent  conversation;  that  he 
is  putting  forth  great  strength;  that  all  is  going  well.  Such 
drug  deception  is  similar  to  that  which  occurs  with  other 
narcotics,  as  chloroform  and  opium. 

While  it  is  true  that  there  is  a  primary  increase  of  mental 


264  MILITARY  HYGIENE 

activity,  this  is  more  than  counterbalanced  by  the  fact  that 
all  reactions  requiring  nicety  of  judgment  are  dulled,  even 
by  small  amounts  of  alcohol.  This  increase  is  soon  followed 
by  a  lowering  in  output  as  well  as  in  quality  of  intellectual 
work,  the  early  excitation  giving  place  to  nervous  depression 
and  weakness. 

Continued  overindulgence  frequently  produces  mental 
aberrations.  A  careful  observer  (Hirsch'l)  has  estimated 
that  nearly  21  per  cent,  of  lunatics  suffer  from  alcoholic 
insanity. 

Coming  down  the  scale  of  nervous  functions,  we  find  that 
chronic  alcoholism  tends  to  produce  disease  in  the  mechanism 
presiding  over  voluntary  movements.  Such  disease  may 
be  entirely  or  principally  manifested  either  in  the  brain 
cortex  (which  originates  the  nervous  impulse),  in  the  cere- 
bellum (where  the  mechanism  of  muscular  co-ordination 
resides),  in  the  spinal  cord  (which  transmits  and  relays  the 
impulse),  or  in  the  terminal  nerves  carrying  that  impulse 
to  the  muscles  themselves. 

On  the  Circulatory  System. — The  circulatory  system 
comprises  the  heart,  the  blood-vessels,  and  the  blood,  all  of 
which  may  be  injuriously  affected  by  habitual  alcoholic 
indulgence. 

Heart. — There  is  a  marked  difference  of  opinion  among 
investigators  as  to  whether  alcohol  stimulates  the  heart. 
Those  who  have  most  recently  studied  this  phase  of  the 
subject  find  it  is  not  a  true  circulatory  stimulant,  and  that 
moderate  or  large  doses,  by  acting  directly  on  the  heart 
muscle,  cause  weakening  and  a  tendency  to  dilatation  of  that 


ALCOHOL  AND  OTHER  NARCOTICS  265 

organ.  A  brief  rise  of  the  pressure  within  the  blood-vessels 
does,  however,  occur  and  the  pulse  feels  fuller  and  stronger. 
The  capillaries  on  the  surface  of  the  body  are  dilated,  thus 
giving  a  sensation  of  warmth  and  causing  flushing  of  the 
face.  As  radiation  of  heat  from  the  skin  is  increased,  how- 
ever, the  temperature  of  the  body  is  actually  lowered.  In 
a  debauch  such  lowering  may  amount  to  several  degrees, 
which  explains  why  drunken  men  are  so  prone  to  pneumonia 
and  freezing.  Long-continued  use  of  spirits  tends  to  infiltra- 
tion and  degeneration  of  the  heart  muscle.  Beer  drinkers 
acquire  a  characteristic  cardiac  enlargement  due  to  the  depo- 
sition of  quantities  of  fat. 

The  effect  of  continued  use  of  alcohol  upon  the  blood- 
vessels is  that  of  a  chronic  irritant  in  the  circulating  medium; 
stiffness  and  loss  of  elasticity  in  the  arteries,  with  dilata- 
tion of  the  veins,  results.  Such  vessels  are  liable  to  rupture 
under  the  strain,  and  this  tendency  is  especially  noticeable 
in  the  minute  arteries  of  the  brain,  producing  the  condition 
known  as  apoplexy.  As  for  the  blood  itself,  alcohol  appears 
to  narcotize  the  white  cells,  diminishing  their  activity;  to 
interfere  with  the  most  important  function  of  the  red  cells, 
that  is,  their  oxygen-yielding  capacity;  and  to  impair  the 
bactericidal  power  of  the  serum. 

On  the  Digestive  System. — Small  amounts,  taken  before 
a  meal,  increase  the  flow  of  gastric  juice,  but  diminish  the 
normal  movements  of  the  stomach.  Unless  employed  in 
high  dilutions  alcohol  exerts  a  decidedly  irritant  effect  upon 
the  stomach.  Dyspepsia,  catarrh,  and  gastritis  due  to  this 
substance  are  quite  common,  the  character  of  these  condi- 


266  MILITARY  HYGIENE 

tions — whether  mild  or  severe,  acute  or  chronic — depending 
upon  the  quantity  and  the  concentration  of  the  ingested 
irritant  and  the  duration  of  the  overindulgence.  But  it  is 
upon  the  liver,  of  all  the  digestive  organs,  that  alcohol 
exerts  its  most  marked  and  characteristic  action.  Here  we 
find  the  condition  known  as  "gin-drinker's"  or  "hob-nailed" 
liver,  the  latter  term  being  well  descriptive  of  the  external 
appearance  of  the  organ.  As  with  the  heart,  beer  is  more 
likely  to  cause  hepatic  fatty  degeneration  and  infiltration 
than  cirrhosis. 

On  the  Kidneys. — It  is  the  function  of  the  kidneys  to  take 
from  the  body  a  large  part  of  the  waste  materials  engendered 
by  the  activity  thereof.  Anything  that  interferes  with  their 
work  will  in  time  cause  retention  of  poisonous  waste  products 
within  the  body,  to  the  detriment  of  the  entire  economy. 
Alcohol,  persistently  taken,  has  such  an  effect  upon  the  kid- 
neys and  is  frequently  responsible  for  the  pathologic  changes 
included  under  the  name  of  chronic  Bright's  disease.  The 
process  is  commonly  a  hardening,  as  in  many  other  parts  of 
the  body. 

On  the  Visual  Apparatus. — Steady  drinking  is  not  infre- 
quently responsible  for  a  serious  impairment  of  vision  and 
even  blindness,  due  to  degeneration  of  the  optic  nerve. 

On  the  Generative  Function. — Alcohol  increases  sexual 
desire  and,  by  destroying  natural  caution,  is  indirectly 
responsible  for  a  great  amount  of  venereal  disease.  Children 
of  hard  drinkers  are  peculiarly  prone  to  be  born  weak- 
minded,  epileptic,  and  physically  feeble. 

General  Effects. — Recent  investigators  are  very  generally 


ALCOHOL  AND  OTHER  NARCOTICS  267 

agreed  that  the  continued  use  of  alcohol  produces  a  diminu- 
tion of  bodily  vitality  and  of  resisting  power  to  disease. 
Experimental  work  and  clinical  experience  coincide  in  this 
finding.  In  experiments  recently  concluded  it  was  found 
that  animals  which  for  a  few  weeks  or  months  had  received 
amounts  of  alcohol  too  small  to  cause  any  symptoms  of 
intoxication,  succumbed  to  poison  administered  in  doses  so 
minute  as  to  produce  no  effect  upon  other  animals  which  had 
not  received  alcohol.  The  natural  resistance  of  red  blood- 
corpuscles  is  lessened,  the  phagocytic  action  of  white  blood- 
cells  is  inhibited,  and  the  germ-destroying  properties  of 
normal  blood-serum  are  impaired.  The  oxygen  which  is 
carried  in  combination  with  the  hemoglobin  of  the  red  cor- 
puscles is  retained  in  such  combination  instead  of  being 
yielded  up  to  the  tissues,  while  the  excretion  of  waste  materials 
is  checked.  Thus  the  defenses  of  the  body  are  lowered,  the 
liability  to  disease  is  intensified,  the  capacity  for  recovery 
lessened.  Senile  changes  are  accelerated;  the  prognosis 
after  injuries  or  surgical  operations  is  graver  and  more  un- 
certain; the  tendency  to  obesity  and  to  gouty  affections  is 
marked;  the  mortality  in  pneumonia,  tuberculosis,  fevers, 
and  inflammations  is  much  higher. 

The  advocates  of  a  regular  and  moderate  use  of  alcohol 
have  based  their  arguments  largely  upon  its  value  as  a  food 
and  as  a  medicine.  Let  us,  therefore,  examine  into  its 
merits  in  these  particulars. 

Alcohol  as  a  Food. — The  question  as  to  the  nutritive 
properties  of  alcohol,  as  used  by  individuals  in  a  state  of 
health,  has  been  debated  more  earnestly  than  any  other, 


268  MILITARY  HYGIENE 

and  the  range  of  views  is  still  wide.  Such  range  is  con- 
tracting, and  the  advocates  of  its  use  in  moderate  quantities 
— especially  in  the  medical  profession — are  lessening  yearly. 
On  the  one  hand,  certain  physiologists  maintain  that  alco- 
hol can  be  burned  in  the  body;  that  it  may  be  a  source  of 
heat  and  energy;  and  that,  like  fats  and  carbohydrates,  it 
acts  as  a  protein-sparer,  that  is,  a  preventer  of  undue  waste 
of  this  important  constituent  of  the  body  tissues.  In 
persons  accustomed  to  its  use  98  per  cent,  of  moderate 
doses  (not  more  than  3  tablespoonfuls  per  day)  are  consumed 
in  the  body.  If  more  than  that  amount  is  taken,  the  excess 
is  excreted,  unchanged,  by  the  lungs  and  kidneys.  It  is  but 
fair  to  conclude  that  such  moderate  amounts  are  utilized 
for  the  purposes  of  the  body  in  the  manufacture  of  heat  and 
certain  forms  of  energy.  Although  alcohol  may  furnish 
energy,  it  is  not  yet  determined  w^hence  the  body  derives 
such  energy — whether  from  the  alcohol  itself  or  from  fats 
or  carbohydrates  which  are  metabolized  by  it.  As  for  the 
tissue-sparing  properties  of  this  substance,  it  seems  certain 
that  these  are  more  apparent  than  real,  the  conditions  noted 
being  due  to  its  narcotic  effect,  which,  by  decreasing  activity, 
diminishes  oxidation.  It  is  manifest  that  it  is  not  a  practi- 
cable food  (comparable  with  carbohydrates  for  instance), 
as  it  disturbs  the  metabolism  of  foods  proper  and  throws 
waste  materials,  which  are  inimical  to  health,  into  the  cir- 
culation. 

From  the  foregoing  it  may  be  seen  that  while  the  energy 
produced  by  alcohol  in  small  quantities  may  be  utilized  by 
the  body  for  its  purposes,  its  beneficial  action  in  this  par- 


ALCOHOL  AND  OTHER  NARCOTICS  269 

ticular  is  but  slight  and  is  more  than  neutralized  by  unde- 
sirable effects  produced  elsewhere.  Such  is  the  conclusion 
that  has  been  reached  by  most  men  who  have  studied  this 
problem. 

Alcohol  as  a  Medicine. — (a)  The  medicinal  qualities  of  al- 
cohol as  an  aid  to  digestion  have  long  been  urged.  Such  use 
is  without  the  support  of  clinical  or  laboratory  evidence, 
however,  for  while  small  amounts  in  dilute  solutions  (1  to  2 
per  cent.)  increase  the  flow  of  gastric  juice,  the  digestive 
powers  of  the  stomach  are  rapidly  depressed,  with  increase 
of  alcoholic  percentage.  The  retardation  of  digestion  is 
commensurate  with  the  two  factors — strength  of  digestive 
agent  and  percentage  of  alcohol;  2  to  3  per  cent,  is  enough  to 
interfere  with  pancreatic  as  well  as  gastric  digestion.  So, 
the  results  of  the  inquiry  into  this  phase  of  the  question  may 
be  stated  thus:  Strong  digestions  do  not  need  it  and  weak 
ones  are  disturbed  by  it. 

(/;)  Alcohol  is  generally  regarded  as  a  stimulant,  that 
is,  an  agent  which  produces  a  temporary  increase  of  vital 
activity.  It  has  appeared  in  the  foregoing  discussion, 
however,  that  this  substance  does  not  produce  a  true 
stimulation.  The  observed  effects  are  chiefly,  if  not  wholly, 
due  to  its  narcotic  effect  on  the  nerve-centers,  lessening  the 
sense  of  pain,  fatigue,  or  other  discomfort.  When  em- 
ployed for  such  purpose,  in  conditions  of  exhaustion,  in  the 
prostration  of  severe  acute  fevers,  and  in  general  infections, 
especially  at  times  when  food  cannot  be  administered,  it 
undoubtedly  has  a  certain  value.  Yet  even  here  its  bene- 
ficial action  is  apt  to  be  impaired  by  its  objectionable  quali- 


270 


MILITARY  HYGIENE 


ties;  furthermore,  there  are  real  stimulants  of  greater  utility 
and  less  risk. 

(c)  It  was  long  thought  by  the  medical  profession  that 
alcohol  was  of  great  value  in  tuberculosis.     Exact  obser- 
vations   and    statistics    have    proved,    however,    that    far 
more  people  with  this  disease  have  been  injured  by  its 
use  than  benefited.      In   heart  disease,  surgical  shock,  and 
snake-bite — conditions  of   cardiac  and   nervous   depression 
in  which  it  was  formerly  much  employed — it  is  harmful, 
since,   in  the   large  doses  necessary  for  such  cases,  it  is 
depressant  to  the  circulatory  and  nervous  systems. 

(d)  An  alcoholic  drink  may  at  times  be  useful  as  a  re- 
storative in  fatigue  following  hard  labor.     It  is  useless  in 
combating  the  effects  of  exposure  to  cold.     If  employed 
before  or  during  work  (physical  or  intellectual)  it  usually 
lowers  the  output  of  such  work,  both  as  to  quantity  and 
quality.     It  will  enable  a  brief  muscular  spurt  to  be  made, 
but  will  not  give  sustained  power.     On  the  contrary,  its  use 
is  soon  followed  by  a  reduction  of  energy  below  the  normal. 

Summary  and  Discussion  with  Regard  to  the  Use  of  Alcohol  as  a 

Beverage 

The  effects  of  alcohol,  useful  and  deleterious,  as  set  forth 
in  the  preceding  pages,  may  be  summarized  as  follows: 


FOR. 

AGAINST. 

Cells  of  body. 
Nervous  system: 
(a)  Cells. 

Diminishes  activity. 

Is    a    poison    to    all    cells; 
possesses  a  special  and  in- 
jurious affinity  for  nerve- 
cells. 

ALCOHOL  AND  OTHER  NARCOTICS 


271 


FOB. 


AGAINST. 


Nervous  system: 
(6)  Brain. 

(c)  General. 

Circulatory  system : 
(a)  Heart  | 

(6)  Blood-vessels  j 


(c)  Heat  mechan- 
ism. 

Digestive  system : 
(a)  Stomach. 


(6)  Pancreas. 
(c)  Liver. 

Kidneys. 

Eyes. 

Generative  function. 


General  effects: 
(a)  Vitality. 
(6)  Resistance    to 

disease, 
(c)  Nutrition. 


As  a  food. 


As  a  medicine: 
(a)  Digestive  aid. 
(6)  Stimulant, 
(c)  Narcotic. 


Small  amounts  cheer. 


Stimulates  (?)  feebly 
and  briefly. 


Slightly  increases 
flow  of  gastric 
juice. 


Small  amounts  oxi- 
dized in  body  to 
produce  heat,  to 
diminish  tissue 
waste,  and  to  sus- 
tain strength  in 
conditions  of  ex- 
haustion. 


Lessens  sense  of  dis- 
comfort, pain,  and 
fatigue. 


Mental  processes  interfered 
with. 

Mental  and  nervous  dis- 
eases frequently  follow 
continued  use. 

Fatty  or  fibrous  degenera- 
tion in  steady  drinkers. 

Fibrous  degeneration  in 
steady  drinkers,  with 
tendency  to  apoplexy. 

Produces  fall  in  body  tem- 
perature. 


Diminishes  motility  and 
digestive  power. 

Small  amounts  impair  di- 
gestion. 

Fatty  degeneration  and 
cirrhosis  in  steady 
drinkers. 

Bright's  disease  in  steady 
drinkers. 

Degeneration  of  optic  nerve. 

Excites  passion;  increases 
liability  to  venereal  dis- 


Diminished. 
Lessened. 

Tendency  to  gout,  fatty 
deposits,  and  accelerated 
senile  changes. 

Not  a  true  food;  undesir- 
able effects  produced 
elsewhere  balance  good 
qualities  in  this  regard. 


Doubtful. 

Not  a  true  stimulant. 


272  MILITARY  HYGIENE 

The  foregoing  summary  indicates  how  difficult  it  is  to 
make  a  favorable  showing  for  alcohol.  As  a  stimulant  it  is 
uncertain  and  risky,  while  there  are  much  richer  available 
sources  of  food. 

Poisonous  Effects. — It  follows,  from  the  evidence  submit- 
ted, that  alcohol  is  a  narcotic  poison — to  protoplasm,  nerve- 
cell,  and,  in  fact,  when  in  sufficient  dose,  to  all  the  tissues  of 
the  body.  The  term  poison  is  a  relative  one  and  means  any 
substance  which  kills  living  tissue  or  impairs  its  function. 
So  sensitive  is  the  nervous  system  to  the  action  of  alcohol, 
even  when  taken  in  amounts  so  small  that  no  effects  can  be 
recognized  by  the  persons  under  observation,  that  it  uniformly 
causes  measurable  changes  in  acuteness  of  the  senses,  mental 
processes,  muscular  power  and  endurance,  and  these  effects 
last  for  many  hours.  On  other  tissues  and  in  different  per- 
sons it  acts  in  varying  degree,  according  to  individual  sus- 
ceptibility. Idiosyncrasy  plays  a  most  important  part. 
There  is  no  constant  and  definite  relation  between  the 
amount  of  alcohol  consumed  and  its  pathologic  effects.  In 
one  person  the  brain  may  be  the  organ  chiefly  damaged; 
in  another,  the  kidney;  in  a  third,  the  heart.  It  must  not 
be  assumed  that  all  or  any  of  the  disease  processes  men- 
tioned inevitably  follow  the  use  of  alcohol,  since  many  per- 
sons show  a  marked  resistance  to  its  irritant  and  narcotic 
effects.  On  the  other  hand,  such  effects  are  by  no  means 
limited  to  persons  recognized  as  intemperate,  but  are  often 
encountered  in  those  whose  use  of  alcohol  has  been  regarded 
as  "moderate."  It  is  generally  agreed  that  the  mortality 
from  diseases  of  the  heart,  blood-vessels,  nervous  system,  kid- 


ALCOHOL  AND  OTHER   NARCOTICS  273 

ney,  and  liver  is  much  higher  in  drinking  men  than  in  ab- 
stainers. 

Effect  on  Longevity. — British  life  insurance  companies 
that  but  a  generation  or  so  ago  regarded  "teetotallers"  as 
extra-hazardous  risks,  now  report  that  the  expectation  of  life 
is  shortened  nearly  20  per  cent,  in  habitual  users  of  alcohol. 
To  put  this  in  another  form,  an  English  actuary  states  that 
of  every  100,000  moderate  drinkers,  44,000  reach  seventy 
years,  and  of  every  100,000  abstainers,  55,000  attain  that 
age. 

Change  in  Sentiment. — The  alteration  of  policy  just 
mentioned  affords  a  striking  example  of  the  change  in  senti- 
ment upon  this  vital  subject  which  has  occurred  within  the, 
last  few  years.  An  entire  agreement  of  medical  opinion  has 
by  no  means  been  attained.  It  is  significant,  however,  that 
a  large  percentage  of  physicians  have  ceased  to  employ  it  in 
their  practice,  and  that  most  of  those  who  still  utilize  it,  do 
so  in  greatly  diminished  quantities.  As  in  the  evolution 
of  all  medical  practice,  former  beliefs  concerning  the  effects 
of  alcohol  were  founded  on  experience  and  observation — 
which  in  this  case  were  very  likely  helped  out  by  inclination. 
Thus,  results  so  attained  were  often  wrongly  interpreted. 
Of  late  years  the  subject  has  shared  in  the  general  scientific 
investigation  of  matters  imperfectly  understood,  and  a 
great  advance  has  been  made  in  our  knowledge.  Conse- 
quently, earlier  views  as  to  the  usefulness  and  beneficence 
of  alcoholic  drinks  have  been  greatly  amended.  The  major- 
ity of  scientists  who  have  studied  the  subject  have  become 
opponents  of  its  use.  It  was  not  so  long  ago  that  the  "grog 

18 


274  MILITARY  HYGIENE 

ration"  was  a  regular  issue  in  our  army,  and  for  years  after 
its  abolition  we  adhered  to  the  custom  (borrowed  from  the 
British  military  law)  of  adjourning  courts-martial  at  3  p,  M., 
"since  no  gentleman  was  expected  to  be  sober  after  that 
hour."  At  the  present  time  the  use  of  alcohol  by  officers  is 
steadily  lessening,  and  the  general  sentiment  is  strongly  ad- 
verse to  those  who  at  any  time  show  its  effects. 

Moderation. — Assuming,  for  the  sake  of  argument,  that 
the  habitual  and  moderate  ingestion  of  alcohol  is  in  some  sort 
beneficial  to  the  body,  it  is  now  pertinent  to  inquire  if  there 
is  such  a  thing  as  moderation  in  the  use  of  this  substance. 
The  term  moderation  is  misleading  and  hard  to  define. 
What  is  moderate  for  one  is  immoderate  for  another.  A 
century  ago  our  "3-bottle"  ancestors  were  considered  to 
be  moderate  drinkers.  Now  less  than  1  ounce  is  found  to 
be  harmful  to  many.  Physiologically,  a  moderate  amount 
of  alcohol  may  be  defined  as  that  quantity  which  may  be 
completely  burnt  up  in  the  body.  Scientific  investigation 
has  shown  that  such  quantity,  'for  the  average  individual, 
does  not  exceed  1  \  ounces  per  day,  and  that  oxidation  is  then 
accomplished  only  when  the  alcohol  is  taken  in  small,  highly 
diluted  doses.  If,  therefore,  there  is  a  moderate  permissible 
quantity,  it  is  at  least  certain  that  this  is  represented  by  1 
to  2  glasses  of  wine  or  a  pint  of  beer  in  twenty-four  hours. 
This  is  best  taken  at  meals  and  especially  with  the  last  meal 
of  the  day. 

Formation  of  the  Habit. — Since  the  dawn  of  history  men 
have  felt  a  desire  for  some  agent  which  would  widen  the 
range  of  emotional  life;  something  to  heighten  their  pleasures 


ALCOHOL  AND  OTHER  NARCOTICS  275 

or  to  dull  their  miseries.  This  need  has  been  supplied  by 
alcohol,  opium,  hashish,  and  certain  other  narcotics.  The 
widespread  use  of  alcohol  is  due  to  its  effect  in  this  direction, 
together  with  its  recognized  properties  as  an  aid  to  the  social 
side  of  life.  The  habit  of  alcoholic  indulgence  is  easily  formed, 
since  many  factors  besides  those  just  mentioned  are  con- 
tributory. Heredity,  an  unstable  nervous  system,  force  of 
example,  fear  of  ridicule,  environment,  mental  strain,  idle- 
ness, fatigue,  a  craving  for  excitement,  are  some  of  these 
factors.  When  taken  as  a  daily  drink,  alcohol  causes  sensa- 
tions and  effects  which  in  time  are  imagined  to  be  a  neces- 
sary part  of  life.  The  stomach,  for  instance,  becomes  de- 
pendent upon  the  regular  dose  and  disinclined  to  work  with- 
out it. 

Military  Considerations. — Opinion  among  military  experts 
all  over  the  world  is  now  general  to  the  effect  that  the  use 
of  alcohol  results  in  much  inefficiency.  It  is  well  under- 
stood by  all  who  control  large  bodies  of  men  that  alcohol 
and  effective  work  are  incompatible.  Abundant  liquor 
means  a  full  guard-house  and  many  court-martial  cases. 
In  the  matter  of  target  shooting,  careful  experiments  con- 
ducted in  Sweden  showed  an  average  of  40  per  cent,  fewer 
hits  by  marksmen  after  one  drink  of  brandy.  Since  alcohol 
markedly  interferes  with  the  mental  processes,  it  is  plain 
that  decisions  in  military  crises  are  apt  to  be  faulty.  Alco- 
holism and  venereal  disease  are  closely  allied,  and  the  ad- 
mission rates  for  both  of  these  conditions  are  higher  in  the 
United  States  Army  than  in  any  other. 

There  is  one  consideration,  however,  which  at  present 


276  MILITARY  HYGIENE 

qualifies  the  objections  to  the  use  of  alcohol  as  a  beverage  in 
our  service.  Many  men  enter  the  army  who  in  civil  life 
have  accustomed  themselves  to  its  use.  Moreover,  saloon 
men  take  advantage  of  the  close  alliance  which  exists  between 
gambling,  venery,  and  alcoholism.  Such  being  the  case,  the 
"canteen"  feature  of  the  post  exchange  has  proved  valuable 
by  enabling  the  soldier  to  obtain  drinks  having  a  small 
alcoholic  content,  at  home-  and  free  from  the  temptations 
of  the  saloon.  The  canteen  is  thus  the  friend  of  decency  and 
of  discipline. 

Solution  of  the  Liquor  Problem. — Against  the  general  mis- 
use of  alcohol,  legislative  measures — prohibition,  local 
option,  high  license,  state  dispensaries,  and  the  like — have 
proved  ineffective.  The  solution  of  the  liquor  problem  rests 
in  the  gradual  education  of  the  public  as  to  the  harmful 
effects  following  the  use  of  alcohol. 

Conclusions. — Under  normal  physical  conditions  alcohol 
is  never  necessary  and  is  usually  undesirable.  It  does  not 
give  power  nor  capacity.  It  does  not  prevent  fatigue  nor 
ward  off  the  effects  of  cold.  It  interferes  with  the  higher 
mental  faculties  and  is  thus  responsible  for  many  errors  and 
accidents.  It  lessens  the  sense  of  proportion,  responsibility, 
and  restraining  impulses,  and  leads  to  the  formation  of  the 
habit,  with  resultant  evils  to  the  individual  and  to  society. 

Nature  and  Effects  of  Narcotics  Other  than  Alcohol 

Drugs  used  habitually  for  their  special  effect  upon  the 
nervous  system  are  employed  for  one  of  two  purposes: 
first,  to  produce  a  general  sense  of  well-being;  second,  to 


ALCOHOL  AND  OTHER  NARCOTICS  277 

allay  a  discomfort.  Some  of  the  substances  here  discussed 
(as  alcohol,  opium,  cocain)  are  used  at  times  for  either  of 
these  effects.  Others  (as  coffee,  tobacco,  chloral)  fulfil  but 
one  of  these  conditions. 

(a)  Opium  and  its  Derivatives. — Nature. — Opium  is  the 
dried  juice  obtained  by  incising  the  unripe  seed  capsules  of 
the  white  poppy;  commercially  it  occurs  in  brownish,  irreg- 
ular lumps.  It  has  many  derivatives,  all  of  which,  broadly 
speaking,  act  upon  the  body  similarly  to  the  crude  drug; 
chief  of  these  is  the  alkaloid  morphin;  others  are  codein  and 
heroin,  which  sometimes  replace  morphin  in  the  formation 
of  the  habit. 

Effects. — Opium  is  a  narcotic  poison,  whose  final  action 
is  depressant  to  the  tissues  and  more  especially  to  the  ner- 
vous system.  In  many  persons  the  drug,  while  a  true  seda- 
tive, relieving  pain  and  discomfort,  may  at  the  same  time 
produce  a  temporary  stimulant  effect,  conferring  a  feeling 
of  comfort  and  of  increased  mental  and  physical  vigor.  It 
is  the  association  of  these  results  which  constitutes  its  at- 
tractiveness and  often  leads  to  the  formation  of  the  habit. 
Later,  the  chronic  user  takes  the  drug  less  for  the  effects 
cited  than  for  the  relief  of  the  craving,  which  is  described  as 
"a  horrible  sensation." 

Habit. — Opium  is  taken  in  various  ways  by  its  habitues. 
The  crude  drug  is  inhaled  by  smoking;  its  preparations  may 
be  swallowed;  while  morphin  is  most  often  injected  beneath 
the  skin  by  means  of  a  hypodermic  syringe.  Its  victims 
become  pale,  irritable,  unsociable,  unreliable,  and  mentally 
and  physically  depressed.  They  have,  however,  following 


278  MILITARY  HYGIENE 

a  fresh  dose,  periods  of  exaltation  during  which  they  seem 
normal  or  even  excited. 

Craving. — This  drug,  perhaps  more  than  any  other,  has 
the  property  of  creating  a  craving  and  leading  to  the  forma- 
tion of  a  habit  which  imperiously  dominates  the  will.  The 
course  and  termination  of  such  a  case  is  typical.  The  vic- 
tim requires  increasingly  larger  doses  to  solace  the  craving. 
Distressing  functional  disturbances  occur,  as  palpitation  of 
the  heart,  oppressed  breathing,  colic,  insomnia  or  night- 
mares, with  such  mental  aberrations  as  irresolution,  melan- 
choly, and  perversion  of  the  moral  sense. 

Overdose. — The  characteristic  symptoms  of  an  overdose 
of  an  opiate  are  contracted  pupils  and  a  rate  of  breathing 
much  below  the  normal. 

Akohol  and  Opium. — A  comparison  between  the  general 
effects  of  opium  and  alcohol  discloses  striking  differences. 
Opiumism  is  a  solitary  habit;  alcoholism,  a  convivial  one. 
Opium  does  not  usually  produce  tissue  degeneration,  while 
alcohol  causes  extensive  pathologic  changes.  The  one  quiets 
the  passions,  the  other  inflames  them.  Habitue's  of  the 
first  are  not  excited  to  crime  by  its  use  as  those  of  the  second 
often  are,  although  one  craving  the  drug  may  resort  to  any 
means,  however  desperate,  to  obtain  it. 

The  use  of  this  substance  is  increasing  rapidly  among  our 
people  and  importations  far  exceed  the  therapeutic  needs. 
The  recent  enforcement  of  the  Food  and  Drugs  Law,  re- 
quiring that  the  ingredients  of  nostrums  be  given  on  the 
label,  disclosed  the  fact  that  cough  and  soothing  syrups 
generally  contained  an  opiate.  These  have  been  responsible 


ALCOHOL  AND  OTHER  NARCOTICS  279 

for  the  formation  of  the  habit  in  many  innocent  persons, 
including  infants. 

(6)  Cocain. — Nature. — Cocain  is  an  alkaloid  obtained 
from  the  dried  leaves  of  a  South  American  plant,  the  ery- 
throxylon  coca.  When  used  in  susceptible  situations,  it  is  a 
local  anesthetic  of  marked  power.  Absorbed  into  the  blood 
in  sufficient  dose,  it  is  a  narcotic  poison,  which,  like  those 
previously  discussed,  has  a  special  effect  upon  the  nervous 
system  and  tends  to  the  formation  of  a  habit.  Taken  at 
first  to  relieve  pain  or  discomfort,  the  pleasure  derived  from 
it  persuades  its  victim  to  continue  its  use. 

Effects. — The  main  effect  for  which  the  drug  is  taken  is  a 
sense  of  exhilaration  and  refreshment.  A  buoyant  feeling 
replaces  weariness;  the  subject  is  active,  talks  freely,  and  en- 
joys everything.  Later,  hallucinations  and  delusions  appear; 
voices  are  heard  and  vague  fears  are  felt. 

Habit. — The  habit  produces  a  train  of  ill  effects  which 
supervene  more  promptly  than  with  alcohol  and  opium  ad- 
dictions. The  dose  tends  to  increase  rapidly.  The  cocain- 
ist  becomes  a  pallid,  nervous,  emaciated  dyspeptic,  and 
suffers  also  from  loss  of  memory,  impaired  quality  of  work, 
and  diminished  ethical  sense.  Insanity  is  a  common  sequel. 
Cocainism,  like  the  opium  habit,  is  a  solitary  vice.  A  pecu- 
liarity of  its  habitues  is  that  they  will  take  any  other  nar- 
cotic to  replace  the  cocain,  if  that  is  not  obtainable,  or  to 
conceal  its  effects.  The  drug  is  most  commonly  taken  by 
snuffing  the  powder  or  a  solution  up  the  nostrils.  It  forms 
a  part  of  many  catarrh  snuffs,  which,  therefore,  should  be 
avoided  unless  properly  prescribed. 


280  MILITARY  HYGIENE 

(c)  Tobacco. — Nature. — Tobacco  depends  for  its  influ- 
ence on  the  body  upon  the  contained  nicotin.  This  is  an 
exceedingly  poisonous  alkaloid  which  is  found  in  small 
quantities  in  the  leaf  of  the  plant. 

The  use  of  tobacco  is  more  widely  spread  than  that  of  any 
other  narcotic.  The  "divine  weed"  has  many  devotees  who 
claim  it  possesses  no  unwholesome  qualities.  By  others 
it  is  denounced  as  wholly  pernicious.  The  truth,  no  doubt, 
lies  between  these  extremes. 

Effects. — Tobacco  is  a  narcotic,  whose  use,  like  that  of 
alcohol,  opium,  and  cocain,  induces  a  habit.  It  exerts  a 
depressant  influence  upon  the  nervous  system  and  the  cir- 
culation, and  its  continued  employment  by  susceptible  indi- 
viduals causes  throat  irritation,  nervous  dyspepsia,  cardiac 
palpitation,  shortness  of  breath,  disturbed  sleep,  and  failure 
of  vision. 

It  seems  well  established  that  the  habit  retards  the  growth 
of  adolescents;  also  much  evidence  has  accumulated  to  show 
that  its  use  by  college  students  is  closely  associated  with 
idleness,  lack  of  ambition,  and  low  scholarship.  There  is 
no  doubt  that  its  employment  by  youths  who  have  not 
reached  maturity  is  distinctly  prejudicial. 

It  must  be  admitted,  on  the  other  hand,  that  in  many  in- 
dividuals its  use  is  followed  by  certain  benefits;  these  are 
mental  calm,  dulling  of  physical  discomfort,  a  feeling  of 
contentment,  and  the  ability  to  concentrate  thought. 
The  comfort  derived  from  a  pipe,  in  the  trenches  or  dur- 
ing severe  weather,  is  frequently  noted  in  the  military 
service.  Unlike  the  drugs  heretofore  discussed,  tobacco, 


ALCOHOL  AND  OTHER  NARCOTICS  281 

while  it  may  do  physical  damage,  does  not  disturb  the 
moral  sense. 

Habit. — Despite  its  occasional  good  qualities,  the  fact 
remains  that  tobacco  is  a  poison  whose  tendency  is  to  inter- 
fere with  certain  normal  functions.  When  the  habit  is  con- 
firmed, many  become  as  dependent  upon  it  to  steady  their 
nerves  as  alcohol  or  opium  habitues  are  upon  their  favorite 
drugs.  It  is  apparent,  therefore,  that  even  the  moderate 
use  of  tobacco  is  not  without  possibilities  of  evil,  and  that  it 
cannot  be  indulged  in  habitually  except  at  some  risk.  Cigar- 
ette smoking  as  commonly  practised  is  perhaps  most  likely 
to  be  prejudicial  to  health  because  of  two  factors;  these  are: 
first,  inhalation  into  the  lungs  (where  absorption  of  the  nico- 
tin  is  most  complete) ;  second,  the  cheapness  and  availability 
of  the  cigarette  tend  to  immoderate  use. 

(d)  Other  Narcotic  Drugs. — There  are  certain  other  nar- 
cotic drugs  whose  use  sometimes  degenerates  into  a  vicious 
habit.  Since  such  habit  is  not  very  common  in  this  country, 
these  drugs  will  be  mentioned  merely.  The  more  important 
ones  fall  under  two  classes  in  accordance  with  their  predomi- 
nant physiologic  action.  Class  I  comprises  sleep-producers, 
as  chloral,  ether,  chloroform,  and  Indian  hemp  (hashish). 
Those  of  Class  II  are  pain-dispellers,  of  which  the  coal-tar 
products,  antipyrin,  phenacetin,  aspirin,  and  acetanilid,  are 
the  most  common.  The  drugs  of  the  latter  class  have  the 
additional  disadvantage  of  being  dangerous  cardiac  depress- 
ants. They  are  usually  found  in  the  "headache  powders" 
so  widely  advertised  and  extensively  used.  Such  remedies 


282  MILITARY  HYGIENE 

should,  therefore,  be  viewed  with  suspicion  and  taken  with 
caution. 

(e)  Caffein. — The  discussion  of  this  subject  would  not  be 
complete  without  the  consideration  of  another  class  of  sub- 
stances, namely,  those  dependent  for  their  activity  upon  the 
alkaloid  caffein.  Caffein  is  not  a  true  narcotic,  and  tea  and 
coffee,  the  principal  substances  which  contain  it,  are  stimu- 
lating in  their  effects.  They  have,  however,  a  certain  tend- 
ency to  habit  formation  and  to  the  production  of  functional 
disturbances  of  the  nervous,  circulatory,  and  digestive  sys- 
tems. Intemperance  in  their  use  causes  nervousness,  in- 
somnia, depression,  indigestion,  and  palpitations.  On  the 
other  hand,  when  properly  prepared  and  used  they  are  re- 
freshing, cheering,  and  stimulating.  They  dull  the  sensa- 
tion of  hunger  and  assist  the  user  to  withstand  cold  and 
fatigue.  They  are,  therefore,  of  decided  military  value. 


GLOSSARY 

Abscess.     A  collection  of  pus. 

Adolescent.     A  youth  prior  to  maturity. 

Alkaloid.  An  active  medicinal  principle  of  vegetable  origin  having 
the  chemical  properties  of  a  base. 

Alluvial.     Relating  to  soil  deposits  made  by  flowing  water. 

Anesthetic.     A  drug  that  produces  loss  of  feeling  or  sensation. 

Antibodies.    Substances  in  the  body  which  are  antagonistic  to  disease. 

Antidotal.     Counteracting  poison. 

Antitoxin.  A  substance  prepared  from  the  blood  of  one  animal  for 
injection  into  another  to  resist  some  infectious  disease.  Literal  mean- 
ing, Against  poison. 

Apoplexy.  The  disease  conditions  produced  by  the  rupture  of  a 
blood-vessel,  commonly  in  the  brain. 

Bactericidal.     Destructive  to  bacteria. 
Bacteriology.     The  science  which  treats  of  bacteria. 
Blight's  disease.     Inflammation  of  the  kidney. 

Cadaveric.     Pertaining  to  a  dead  body. 

Capillaries.     The  smallest  blood-vessels. 

Carbohydrates.     Sugars  and  starches  used  as  foods. 

Cardiac.     Pertaining  to  the  heart. 

Catarrh.     Inflammation  of  a  mucous  membrane,  with  free  discharge. 

Cell.  One  of  the  minute  elementary  structures  which  combine  to 
form  a  living  body. 

Cerebellum.  That  division  of  the  brain  which  presides  over  the 
co-ordination  of  muscular  action. 

Cerebrospinal.     Pertaining  to  the  brain  and  spinal  cord. 

Circulating  medium.     The  blood. 

Cirrhosis.  Chronic  inflammation  of,  with  increase  in,  the  fibrous 
framework  of  an  organ. 

Cirrhotic.     Pertaining  to  cirrhosis. 

Clinical.     Pertaining  to  the  observation  of  the  sick. 

Colon.     The  large  intestine. 

Condiment.     Something  used  to  give  relish  to  food. 

283 


284  MILITARY  HYGIENE 

Congestion.     An  excess  of  blood  in  a  part. 

Connective  tissue.  The  fibrous  material  which  binds  together  the 
various  structures  of  the  body. 

Constitutional.     Affecting  the  whole  body. 

Co-ordination.     The  harmonious  working  together  of  different  parts. 

Corpuscles.     Small  cells  which  form  part  of  the  blood. 

Cortex.     The  outer  layers  of  an  organ.  . 

Defecation.     Evacuation  of  the  bowels. 

Degeneration.     Deterioration  of  a  tissue. 

Dehydrate.     To  deprive  of  water. 

Delusion.  A  false  mental  impression  as  to  things  perceived  by  the 
senses. 

Depressant.     A  drug  which  reduces  vital  energies. 

Desiccation.     Drying. 

Digestive  system.  The  organs  of  food  digestion,  made  up  of  the 
alimentary  canal,  (mouth  to  anus),  liver,  and  pancreas. 

Economy.     A  name  for  the  human  body  considered  as  a  whole. 

Epidemic.     Attacking  many  people  at  one  time. 

Excrement.  The  natural  discharges  of  ^the  body,  especially  feces 
and  urine. 

Excrementitious.     Pertaining  to  excrement. 

Excreta.     Same  as  Excrement. 

Excretion.  The  discharge  of  waste  matter  from  the  body,  or  the 
material  so  discharged. 

Fecal.     Pertaining  to  feces. 
Feces.     The  discharges  from  the  bowel. 
Ferment.     A  substance  which  produces  fermentation. 
Flexor.     A  muscle  which  bends  a  joint. 

Fumigation.  The  production  of  smoke  or  vapor  for  disinfection  or 
for  stupefying  insects. 

Functional.     Affecting  the  functions  of  the  body. 

Gastric.     Pertaining  to  the  stomach. 

Gastritis.     Inflammation  of  the  stomach. 

Genitals.     The  sexual  organs. 

Germ.     Any  microscopic  form  of  life. 

Germ  plasm.     The  reproductive  substance  of  living  organisms. 

Germicide.     A  germ  killer. 

Glycogen.     A  carbohydrate  found  in  the  liver  and  muscles. 

Groin.     The  depression  between  the  abdomen  and  the  thigh. 


GLOSSARY  285 

Hallucination.  The  fancied  perception  of  objects  or  sensations 
which  have  no  reality. 

Hemoglobin.     The  red  coloring-matter  of  the  blood. 
Hirsute.     Hairy. 
Hypodermic.     Under  the  skin. 

Idiosyncrasy.  A  peculiarity  by  which  one  person  differs  from 
others. 

Illicit.     Unlawful. 

Immunity.     Security  against  any  particular  disease. 

Incubation  period.  Time  elapsing  between  exposure  to  a  disease  and 
its  manifestation. 

Infection.  The  communication  of  disease  from  one  person  to  an- 
other. 

Infectious.     Liable  to  be  communicated  by  infection. 

Infiltration.  The  accumulation,  in  a  tissue,  of  substances  not  normal 
to  it. 

Infusorial  earth.  Composed  of  the  shells  of  microscopic  marine 
animals. 

Ingestion.     The  act  of  taking  food,  medicines,  etc.,  into  the  body. 

Inhibit.     To  check  or  suppress. 

Intercellular.     Among  or  between  cells. 

Kidneys.     The  two  organs  which  excrete  the  urine. 
Koumiss.     A  fermented  drink  prepared  from  milk. 

Larva.  The  worm-like  stage  in  the  development  of  an  insect  from 
the  egg. 

Larvacide.     Larva  killer. 

Lesion.  Any  change  in  a  part  of  the  body  resulting  from  disease  or 
injury. 

Local.     Restricted  to  one  spot. 

Louver.     A  ventilating  device. 

Malt.     Grain  (usually  barley)  artificially  germinated. 

Meningitis.  Inflammation  of  the  coverings  of  the  brain  or  spinal 
cord. 

Metabolism.  The  power  possessed  by  cells  to  use  up  and  to  renew 
the  matter  composing  the  body. 

Metabolize.     To  transform  by  means  of  metabolism. 

Microbe.     Any  microscopic  form  of  life. 

Mucous  membrane.  The  continuation  of  the  skin  lining  those  cavi- 
ties of  the  body  which  communicate  with  the  external  air. 


286  MILITARY  HYGIENE 

Narcotic.  Any  drug  which  produces  a  condition  of  partial  uncon- 
sciousness. 

Narcotize.     To  put  under  the  influence  of  a  narcotic. 

Nervous  system.  All  collections  of  nerve  tissue  (brain,  spinal  cord, 
sympathetic  system,  and  nerves)  considered  as  a  whole. 

Nostrum.     A  quack,  patent,  or  secret  remedy. 

Organ.     Any  part  of  the  body  having  a  special  function. 

Organic.     Pertaining  to  substances  derived  from  living  organisms. 

Organism.  A  name  applied  to  the  assemblage  of  organs  constituting 
a  living  being. 

Ovate.     Egg  shaped. 

Ovum.  An  egg;  in  this  case,  the  female  reproductive  cell  of  the 
human  species. 

Pancreas.     One  of  the  digestive  organs. 

Pancreatic.     Pertaining  to  the  pancreas. 

Pathologic.     Referring  to  the  phenomena  of  disease. 

Pelvic.  Pertaining  to  the  lower  part  of  the  trunk  of  the  human 
body,  which  is  known  as  the  pelvis. 

Pernicious.     Of  very  injurious  or  deadly  type. 

Phagocytic.  Pertaining  to  certain  cells  which  have  the  power  to 
destroy  germs  or  other  cells. 

Physiologic.     Pertaining  to  the  functions  of  the  body  in  health. 

Pneumonic.     Pertaining  to  the  lungs. 

Potable.     Fit  to  drink. 

Prognosis.     The  prospect  as  to  recovery  from  a  disease. 

Prophylactic.  A  remedy  or  measure  which  tends  to  prevent  dis- 
ease. 

Prophylaxis.     The  prevention  of  disease. 

Proteins,  (a)  Nitrogenous  compounds  which  form  a  large  part  of 
the  body  tissues;  (6)  a  class  of  foods. 

Protoplasm.     The  essential  constituent  of  living  cells. 

Pulmonary.     Pertaining  to  the  lungs. 

Purulent.     Containing  pus. 

Phis.     The  creamy  looking  liquid  resulting  from  suppuration. 

Putrescible.     Capable   of   offensive   decomposition. 

Pyrethrum.     Certain  powdered  plants  used  to  destroy  insects. 

Salivary  glands.  The  organs  in  the  mouth  which  manufacture  the 
saliva  from  the  blood. 

Serous.  Pertaining  to  the  lining  of  those  cavities  of  the  body  which 
are  closed  and  do  not  communicate  with  the  external  air. 


GLOSSARY  287 

Serum,  (a)  The  liquid  part  of  the  blood;  (6)  specially  prepared 
blood-serum  of  animals,  used  in  the  treatment  of  disease. 

Specific  action.  Exerting  a  peculiar  influence  over  any  special 
part  of  the  body. 

Sputum.     The  spittle  ejected  (expectorated)  from  the  mouth. 

Suppuration.  Advanced  inflammation,  resulting  in  the  formation 
of  pus. 

System.     A  set  of  parts  or  organs  which  unite  in  a  common  function. 

Tabloid.  Medicines  or  other  substances  compressed  in  the  form  of  a 
lozenge. 

Therapeutic.     Pertaining  to  the  treatment  of  disease. 

Thermic  rays.     The  heat  rays  of  the  sun. 

Thorax.     The  chest. 

Tissue.  Any  collection  of  similar  cells  united  to  form  some  structural 
part  of  the  body. 

Toxic.     Pertaining  to  poisons. 

Toxicologic.     Pertaining  to  the  study  of  poisons. 

Toxin.     A  poison  produced  by  the  action  of  disease  germs. 

Ulceration.     The  formation  of  an  open  sore. 

Urea.     A  waste  product  of  the  body  found  in  the  urine. 

Vaccine.  Any  material  used  for  preventive  inoculation  (as  anti- 
typhoid vaccine). 

Vasomotor.  Presiding  over  the  contraction  and  expansion  of  blood- 
vessels. 

Venery.     Sexual  intercourse. 

Virus.     Any  animal  poison. 


INDEX 


ABDOMINAL  congestion  in  tropics, 

239 

covering  of  wool  in  tropics,  241 
Absinthe,  261 

Acclimatization,  tropical,  238 
Acetanilid  habit,  281 
Ague,  74 
Air  space,  166 
Alcohol,  35,  258 

and  opium,  comparison,  278 

apoplexy  from,  265 

as  aid  to  digestion,  269 

as  food,  267 

as  medicine,  269 

as  narcotic,  272 

as  restorative,  270 

as  stimulant,  269 

blindness  from,  266 

Bright's  disease  from,  266 

change  in  sentiment  in  regard  to, 

273 

classification,  259 
conclusions  in  regard  to,  276 
denatured,  262 
effects,  general,  266 
on  blood,  265 
on  blood-vessels,  265 
on  brain,  263 
on  cells,  262 

on  circulatory  system,  264 
on  digestive  system,  265,  269 
on  eyes,  266 
on  gastric  juice,  265 
on  generative  function,  266 
19 


Alcohol,  effects  on  heart,  264 

on  kidneys,  266 

on  liver,  266 

on  longevity,  273 

on  nervous  system,  263 

on  resistance  to  disease,  267 

on  stomach,  265 

on  tissues  and  vital  processes, 
262 

on  visual  apparatus,  266 

on  vitality,  267 

poisonous,  272 
ethyl,  258 

formation  of  habit,  274 
general  effects,  266 
habit,  formation,  274 
heat  mechanism,  265 
in  aortic  service,  248 
in  heart  disease,  270 
in  patent  medicines,  262 
in  shock,  270 
in  snake-bite,  270 
in  surgical  shock,  270 
in  tuberculosis,  270 
methyl,  262 

military  considerations,  275 
moderate  use,  274 
nature,  258 

nutritive  properties,  267 
physical  properties,  259 
poisonous  effects,  272 
problem,  solution,  276 
strength,  258 
wood,  262 

289 


290 


INDEX 


Alcoholic  excess,  86 
Ale,  259 
Ameba,  72 

Amebic  dysentery,  72 
American  Army,  antityphoid  vac- 
cination in,  69 
Anatomy,  32 
Animal  starch,  142 
Anopheles  mosquitoes,  74 
Antibodies,  68 
Antimeningitic  serum,  80 
Antipyrin  habit,  281 
Antiseptic,  62 
Antitoxin,  diphtheria,  81 
Antityphoid  vaccination,  67.     See 

also  Vaccination,  antityphoid. 
Apoplexy  from  alcohol,  265 
Arctic  ration,  159 
Arctic  service,  246 

diseases,  246,  247 

disposal  of  refuse,  249 

effects,  246 

personal  hygiene,  249 
Arteries,  38 
Aspirin  habit,  281 
Athletics,  53 

BACILLARY  dysentery,  72 
Bacillus,  60 

comma,  83 

of  dysentery,  61,  72 

of  influenza,  79 

tubercle,  77 

typhoid,  65 
Bacon,  147 
Bacteria,  60 

in  ice,  137 

in  water,  125 
destruction,  135 
removal,  130 
Bakery,  176 
Baking  of  bread,  148 
Balanced  ration,  143 


Bandoleer,  117 

Barracks,  construction,  162 

exposure,  162 

inspection,  177 

messing  in,  174 
supervision,  176 

plumbing  of,  173 

sanitation  of,  172 
Baths,  32 

cold,  32 

hot,  32 

in  camp,  193,  194 

in  tropics,  238 

shower-,  167 
Battlefields,  199 

care  of  wounded,  200 

casualties,  203 

disposal  of  dead,  204 

evacuation  of  sick,  199 

identification  of  dead,  204 

lines  of  sanitary  aid,  200 

sanitary  preparations,  199 
troops,  200 
water-supply,  202 
Bayonet,  117 
Beans,  149 

Bedbugs  on  transports,  180 
Bedding,  care  of,  172 
Beds,  care  of,  172 
Beef,  145 

canned,  147 

refrigeration  of,  146 
Beer,  259 

Belt,  cartridge,  116 
Benedictine,  261 
Beriberi,  84,  159 
Beverages  on  marches,  184 
Biliousness,  37 
Billeting,  187 

Biologic  disposal  of  sewage,  212 
Bites  of  insects,  86 
Biting  flies,  87 
Bivouac,  187 


INDEX 


291 


Black  death,  83 
Blanket,  116 

roll,  115 
Blindness  from  alcohol,  266 

snow-,  247 
Blistered  feet,  87 
prevention,  88 
treatment,  89 

Blood,  effects  of  alcohol  on,  265 
Blood-vessels,  effect  of,  alcohol  on, 

265 

Blouse,  95 
Blues,  fits  of,  39 
Bodily  activity,  necessity  for,  41 

processes,  139 

Boer  War,  typhoid  fever  in,  63 
Boiling  of  meats,  152 

of  water,  137 
Bowels,  care  of,  37 
Box  seats  for  sinks,  221 
Brain,  effects  of  alcohol  on,  263 
Brandy,  260 
Bread,  148 

baking  of,  148 

care  of,  176 

field,  156 

hard,  155 

Breakbone  fever,  82 
Breathing  functions  of  cells,  263 
Breathlessness,  57 
Breeches,  98 

Bright's  disease  from  alcohol,  266 
British    Army,    antityphoid    vac- 
cination in,  68 
Broiling  of  meats,  152 
Broths,  cooking  of,  152 
Buildings,  sanitation  of,  161 
Bunks,  care  of,  172 
Burial  of  dead,  204 

CAFFEIN  habit,  282 
Calories,  143 
Campaign  hat,  95 


Camps,  187 

bathing,  193,  194 
cantonment,  187 
care  of  food,  195 
circular  pit  incinerator,  230 
diarrhea,  73 

prevention,  73 
disposal  of  excreta,  190,  218 
incineration,  218 
straddle  trench,  225 

of  garbage,  226 

of  manure,  229 

of  rubbish,  230 

of  sweepings,  230 

of  urine,  224 

of  wash  water,  233 

of  waste  from  taps,  233 

of  wastes,  190,  218 
drainage,  234 
drinking-water,  193 
equipment  and  supplies,  189 
fixed,  187 
garbage  cans  in,  care  of,  228 

stands  in,  care  of,  228 
guards,  189 
halt  order,  189 
ice-box,  195 
inspections    and    responsibility, 

197 

latrines,  192,  221 
laundry  water,  193,  194 
messing  in,  194 
peddlers,  195 
personal  hygiene,  197 
pits  for  liquid  garbage  in,  228 
police,  196 

preliminary  inspection,  188 
preparation,  188 
sanitation  of,  187 
sinks,  189,  192,  221 
sites,  188 

sod  crematory,  231 
standing,  188 


292 


INDEX 


Camps,  sutlers,  195 

temporary,  187 

types,  187 

watering  animals,  193 

water-supply,  193 
Canned  beef,  147 

vegetables,  156 

Cans,  garbage,  in  camps,  care,  228 
in  garrison,  215 

urinal,  224 
Canteen,  276 

and  cup,  118 
Cantonments,  187 
Caps,  94 
Carbohydrates,  141 

functions,  142 
Carbon,  140 

dioxid,  37 
Care  of  troops,  17 
Carriers,  typhoid,  65,  66 
Cartridge  belt,  116 
Cavalry  equipment,  119 
Cells,  breathing  functions,  263 

definition,  139 

effects  of  alcohol  on,  262 

properties,  139 
Cerebrospinal  fever,  80 
Cesspools  for  excreta,  211 
Chancre,  hard,  254 

soft,  256 
Chancroid,  256 
Changres  fever,  74 
Chartreuse,  261 
Chechawker  knee,  247 
Cheese,  145 
Chemical  composition  of  body,  140 

purification  of  water  in  field,  131 
Chest  measurement  of  recruits,  28 
Chiggers,  86 
Chilblains,  246 
Chill,  avoidance  of,  58 
Chills  and  fever,  74 
Chloral  habit,  281 


Chlorin  gas  purification  of  water 

by,  129 

Chloroform  habit,  281 
Chocolate,  158 
Cholera,  83 

in  tropics,  244 
Circular  pit  incinerator  for  camps, 

230 

Circulatory  system,  effects  of  alco- 
hol on,  264 

Civil  communities,  typhoid  fever 
in,  64 

War,  typhoid  fever  in,  63 
Clap,  255 
Cleanliness  of  surroundings,  39 

personal,  32 
Climate  and  diet,  34 

cold,  246 

effects  of,  246 

tropical,  235 
Climbing,  52 
Clothing,  33,  36,  90 

color,  92 

coolness,  92 

cotton,  91 

in  arctic  service,  248 

in  tropics,  240 

khaki,  92,  93 

merino,  91 

military,  93 

olive  drab,  92,  93 

paper,  92 

purposes,  90 

requirements,  90 

source,  90 

warmth,  92 

waterproofing,  92 

wool,  90 
Coats,  Mackinaw,  96 

military,  95 
Mackinaw,  96 
overcoat,  96 
Cocain,  279 


INDEX 


293 


Cocain,  effects,  279 

habit,  279 

nature,  279 
Codein,  277 
Coffee,  150 

habit,  282 
Cold  bath,  32 

climate,  246 

effects,  246 
Colds,  37 

common,  79 

catching,  79 
Comma  bacillus,  83 
Concentrated  foods,  157 
Congestion,  abdominal,  in  tropics, 

239 

Conscripts,  25,  26 
Constipation,  37 
Consumption,  77 

Contact  filtration  for  sewage  dis- 
posal, 213 
Cooking  in  field,  156 

of  broths,  152 

of  meats,  152 

of  soups,  152 

of  vegetables,  153 

temperature  in,  1 53 
Copper    sulphate,    purification    of 

water  by  addition  of,  128 
Cordials,  261 
Cotton  clothing,  91 
Coughing  in  tuberculosis,  77 
Crematory,  sod,  for  camps,  231 
Crude  oil,  191 
Culex  mosquitoes,  74 
Cuspidors,  care  of,  172 

DARNALL  filter,  131 

for  water  purification  in  field, 

131 

Dead,  disposal  of,  204 
identification  of,  204 
Death-rate,  19 


Denatured  alcohol,  262 
Dengue,  82 
Depots,  recruit,  29 
Dhobie  itch  in  tropics,  244 
Diarrhea,  camp,  73 

prevention  of,  73 
Diet,  34 

and  climate,  34 

faulty,  diseases  from,  159 

in  arctic  service,  247 

in  general,  144 

in  tropics,  239 
Dietary  don'ts,  35 
Digestion,  alcohol  as  aid  to,  269 
;  Digestive  system,  effects  of  alcohol 

on,  265,  269 
Diphtheria,  81 

antitoxin,  81 
Diseases  due  to  infected  food,  159 

from  faulty  diet,  159 

in  arctic  service,  246,  247 

in  tropics,  242 

military  failure  due  to,  18 

prevention  of,  20 

preventable,  18 
Disinfectant,  62 
Disinfection    in    field,    apparatus 

for,  198 

Distilled  liquors,  260 
Double  time  marches,  51 
Drainage,  camp,  234 

in  garrison,  213 
Drawers,  101 
Drinking,  excess  in,  35 
Drinking-water  in  tropics,  240 
Dry  earth  water-closet,  207 
Dump  for  garrison,  218 
Dust  in   transmission  of  typhoid 

fever,  67 
Dusting,  173 
Dysentery,  72 

amebic,  72 

bacillary,  72 


294 


INDEX 


Dysentery  bacillus,  61,  72 
in  tropics,  243 
prevention  of,  73 

EATING,  excess  in,  35 
Education,  hygienic,  42 

physical,  41 
Eggs,  145 

Emergency  rations,  155 
Energy,  potential,  of  food,  143 
Enteric  fever,   63.     See  also   Ty- 
phoid fever. 
Entertainments,  39 
Environment,  42 
Epidemics,  typhoid,  65 
Equipage,    108.     See  also  Equip- 
ment. 

Equipment,  108 
articles,  108 
cavalry,  119 
components,  110 
definition,  108 
fighting,  114 
forms  of  pack,  111 
normal,  113,  114 
table  of  articles,  109,  110 

of  weights,  109 
weights,  108 
Erbswurst,  159 
Esprit,  21 
Ether  habit,  281 
Ethyl  alcohol,  258 
Excess  in  drinking,  35 

in  eating,  35 
Excreta,  disposal  of,  in  camps,  190, 

218 

incineration,  218 
straddle  trench,  225 
in  garrison,  207 
cesspools,  211 
dry  earth  system,  207 
fire,  210 
incineration,  210 


Excreta,  disposal  of,  in  garrison, 

privy,  207 

Public  Health  Service  La- 
trine, 208 

sewerage  system,  211 
Excretory  functions,  36 
Exercise,  38 

effect  of,  on  heart  and  lungs,  38, 

47 

in  tropics,  242 
setting-up,  50 
Exhaustion,  heat,  85 
Eyes,  effects  of  alcohol  on,  266 

FARMING,  sewage,  212 
Fatigue,  57 
Fats,  141 

functions,  142 
Feces.     See  Excreta. 
Feet,  blistered,  87 
prevention  of,  88 
treatment  of,  89 
care  of,  on  marches,  185 
Fez,  94 

Field  bread,  156 
range,  157 

service  in  tropics,  245 
Filter,  Darnall,  131 

for  water  purification  in  field, 

131 
improvised,    for   purification    of 

water  in  field,  134 
Ishiji,  132 

Filtration,  contact,  for  sewage  dis- 
posal, 213 
of  water,  128 
in  field,  131 
percolating,  for  sewage  disposal, 

213 

First-aid  packet,  118 
Flax  fiber,  91 

Flea,  rat,  in  transmission  of  plague, 
83 


INDEX 


295 


Fleas,  87 
Fletcherizing,  34 
Flexion  step,  182 
Flies,  biting,  87 

destruction  of,  170,  174 

in  transmission  of  dysentery,  72 
of  typhoid  fever,  66,  67 

propagation  of,  170 

trap  for,  175 
Floor  space,  166 
Floors,  wooden,  care  of,  172 
Flour,  148 

care  of,  176 
Food,  34,  139 

alcohol  as,  267 

calorie,  143 

care  of,  in  camp,  195 

classes,  141 

concentrated,  157 

definition,  139 

functions,  142 

in  arctic  service,  247 

infected,  diseases  due  to,  159 

materials  accessory  to,  141 

nitrogenous,  140 

potential  energy,  143 

preparation,  139 
Forbes'  sterilizer,  135,  136 
Forced  march,  184 
Franco-Prussian  War,  typhoid  fe- 
ver in,  63 
Freezing,  246 
Frost-bite,  246 
Fruits,  150 
Frying  of  meats,  152 
Functions  of  medical  officers,  18 

GARBAGE  cans  in  camps,  care,  228 

in  garrison,  215 
covers  in  garrison,  215 
disposal  of,  in  camps,  226 

in  garrison,  213 

in  marching  commands,  229 


Garbage  incinerator,  213,  214,  2lo 
liquid,  in  camps,  pits  for,  228 
stands  in  camps,  care,  228 

in  garrison,  215 

Garrison,  disposal  of  excreta,  207 
cesspools,  211 
dry  earth  system,  207 
fire,  210 

incineration,  210 
privy,  207 

Public    Health  Service  La- 
trine, 208 

sewerage  system,  211 
of  garbage,  213 
of  liquid  house  wastes,  216 
of  manure,  216,  217 
of  rubbish,  217 
of  sewage,  212 

biologic  methods,  212 
chemical  treatment,  212 
contact  filtration,  213 
discharge  into  sea  or  other 

waters,  212 
irrigation,  212 
percolating  filtration,  213 
septic  tank,  213 
of  sweepings,  217 
of  wastes,  207 

separation   of   components, 

214 

sewers,  211 
drainage,  213 
dump,  218 
garbage  cans,  215 

stands,  215 
Garters,  102 
Gas,  chlorin,  purification  of  water 

by,  129 
generator     for    disinfection     in 

field,  198 
Gastric  juice,  effects  of  alcohol  on, 

265 
General  order  No,  66,  30 


296 


INDEX 


Generative  function,  effects  of  alco- 
hol on,  266 

German   Army,    antityphoid   vac- 
cination in,  68 

Germs,  60 

Gin,  261 

Gin-drinker's  liver,  266 

Glanders,  160 

Glossary,  283 

Gloves,  99 

Glycogen,  142 

Gonococcus,  255 

Gonorrhea,  255 

transmission  of,  256 

Grog  ration,  273 

Guard-house,  176 

Gymnastic  contests,  53 

Gymnastics,  applied,  53 

HABIT,  acetanilid,  281 

alcohol,  formation  of,  274 

antipyrin,  281 

aspirin,  281 

caffein,  282 

chloral,  281 

chloroform,  281 

cocain,  279 

coffee,  282 

correct,  formation  of,  31 

ether,  281 

hashish,  281 

opium,  277 

phenacetin,  281 

tea,  282 

tobacco,  281 

Habitations  in  tropics,  242 
Hands  in  transmission  of  typhoid 
fever,  66 

washing  of,  after  defecation,  225 
Hard  bread,  155 

chancre,  254 
Hardness  of  water,  124 
Harrington,  quotation,  59 


Harris  incinerator,  220 
Hashish  habit,  281 
Hat  in  tropics,  241 
Hats,  94 

Havard,  (quoted),  252 
Haversack,  115 

rations,  155 
Headache  powders,  281 
Headgear,  94 

in  tropics,  241 
Health,  public,  17 
Heart  disease,  alcohol  in,  270 

effects  of  alcohol  on,  264 
of  exercise  on,  38,  47 
Heat,  effects  of,  85 

exhaustion,  85 

mechanism  of  alcohol,  265 

prickly  in  tropics,  244 
Heating,  166 

direct,  166 

direct-indirect,  166 

indirect,  166 
Heatstroke,  85 
Height  of  recruits,  28 
Helmet,  94,  95 
Heroin,  277 
Hob-nailed  liver,  266 
Homesickness  in  tropics,  244 
Hookworm  disease,  82 
Horseflesh  as  food,  147 
Hot  bath,  32 
Houses  in  tropics,  242 
Hutchinson,  140 
Hydrogen,  140 
Hygiene,  definition  of,  17 

military,  scope  of,  17 

personal,  31 

in  arctic,  249 
Hygienic  education,  42 

ICE,  bacteria  in,  137 
Ice-box  in  camps,  195 
Identification  of  dead,  204 


INDEX 


297 


Identification  tag,  204 
Immunity,  60 

after    antityphoid    vaccination, 

71 

Impotence,  36 
Improvidence  of  soldiers,  22 
Incineration,  190 

of  excreta,  210 

in  camps,  218 

Incinerator,  circular  pit,  for  camps, 
230 

for  excreta,  210 

for  garbage,  213,  214,  215 

Harris,  220 

types  of,  190,  191 
Incinerators    for    excreta,    types, 

219,  220 

Infected  food,  diseases  due  to,  159 
Infection,  60 

prime  source,  62 
Influenza,  79 

bacillus,  79 
Insects,  bites  of,  86 
Inspection  of  barracks  and  posts, 

177 
Intellectual  and  physical  functions, 

interrelation,  44 
Intermittent  fever,  74 
Intestinal  diseases  in  tropics,  243 

parasites  in  tropics,  244 
Intrenching  tools,  117 
Iron  ration,  158 
Ishiji  filter,  132 
Itch,  dhobie,  in  tropics,  244 

mites,  34,  86 
Ivy,  poison-,  87 

JUMPING,  52 

KEPI,  94 

Khaki  clothing,  92,  93 
Kidneys,  care  of,  37 
effects  of  alcohol  on,  266 


Kit  bag,  surplus,  119 
Kitchens,  rolling,  157 
Knapsack  spray  pump,  171 
Knee,  checkhawker,  247 
tenderfoot,  247 

LARVACIDE,  172 

Larvae  of  mosquitoes,  74,  75 

Latrine  orderlies,  225 

Public  Health  Service,  208 
Latrines,  camp,  192,  221 
Laundry  in  camp,  193,  194 

in  tropics,  239 
Leeches,  86 
Leggings,  98 
Leprosy,  85 
Lice,  34,  86 
Life,  length  of,  19 
Lighting,  163 
Lime,  191 

Line  officers,  duties  of,  20 
Linen,  clothing,  91 
Liqueurs,  261 

Liquor  problem,  solution,  276 
Liquors,  distilled,  260 

malt,  259 
Liver,  effects  of  alcohol  on,  266 

gin-drinker's,  266 

hob-nailed,  266 
Load,     soldier's,     110.     See     also 

Pack,  soldier's. 
Longevity,   effect  of    alcohol    on, 

273 
Lungs,  37 

effect  of  exercise  on,  38,  47 

MACKINAW  coat,  96 
Malaria,  74 

in  tropics,  243 

mosquitoes  and,  74 

pernicious,  74 

prevention  of,  76 

transmission  of,  75 


298 


INDEX 


Malt  liquors,  259 

Manure,  disposal  of,  in  camps,  229 

in  garrison,  216,  217 
Marches,  181 

aids,  184 

beverages,  184 

care  of  feet,  185 

days  of  rest,  185 

disposal  of  excreta,  225 
of  garbage,  229 

double  time  51 

factors  affecting,  183 

forced,  184 

halts,  182 

length,  183 

night,  184 

order,  176 

preparation,  181 

principles,  181 

quick  time,  50 

sanitation,  182 

sickness,  185 

thirst,  184 

Marriage  of  syphilitic,  255 
Masturbation,  36 
Measles,  79 
Meats,  145 

boiling  of,  152 

broiling  of,  152 

cooking  of,  152 

extracts,  147 

frying  of,  152 

juices,  147 

powders,  147 

preserved,  146 

refrigeration  of,  146 

roasting  of,  152 

stewing  of,  152 

unusual,  147 

Medical  officers,  functions  of,  18 
Medicines,  patent,  alcohol  in,  262 
Melville,  153 
Meningitis,  cerebrospinal,  80 


Mental  condition  of  recruits,  27 

overwork,  39 
Merino,  91 
Mess,  153 

supervision,  154 
Messing  in  barracks,  174 
supervision,  176 

in  camps,  194 

on  transports,  178 
Methyl  alcohol,  262 
Micrococci,  60 
Micro-organisms,  60 
Military  hygiene,  18 
Militia,  25 
Milk,  144 
Mites,  itch,  34,  86 
Monsoons,  236 
Morphin,  277 

Morse-Boulger  destructor,  213 
Mosquitoes,  87,  171 

anopheles,  74 

culex,  74 

destruction  of,  171,  172 

larval  forms,  74 

malaria  and,  74 

stegomyia,  75 

yellow  fever  and,  82 
Mumps,  80 
Munson  on  shoes,  103 
Munson's    field    disinfection    ap- 
paratus, 197 

NARCOTICS,  258,  276 

National  Guard,  25 

Nervous  condition  of  recruits,  27 
strain  in  arctic  service,  247 
system,    effects    of    alcohol    on, 
263 

Neurasthenia,  39 

Nicotin,  280 

Night  marches,  184 

Nitrogen,  140 

Nitrogenous  foods,  140 


INDEX 


299 


Nostalgia  in  tropics,  245 
Nutritive  properties  of  alcohol,  267 

OAK,  poison-,  87 

Odorless  excavator  system,  191 

Officers,  line,  duties  of,  20 

medical,  functions  of,  18 
Oil,  crude,  191 
Opium,  277 

and  alcohol,  comparison,  278 

craving  for,  278 

effects,  277 

habit,  277 

nature,  277 

overdose,  278 
Order  No.  66,  30 
Orderlies,  latrine,  225 
Overcoat,  96 

Overshirt,  olive  drab,  100 
Overshoes,  107 
Overwork,  mental,  39 
Oxygen,  140 
Ozone,  purification  of  water  by,  129 

PACK,  carriage  of,  114 
carrier,  115 
soldier's,  110 

articles  in,  110 

forms  of,  111 

ideal,  112 

transportation  for,  114 

U.  S.  A.,  new  model,  112 
Packet,  first-aid,  118 
Pain  de  guerre,  156 
Paper  as  clothing,  92 
Parasites,  intestinal,  in  tropics,  244 
Parka,  248 
Parotitis,  80 

Patent  medicines,  alcohol  in,  262 
Pea  sausage,  159 
Peddlers,  195 
Pemmican,  159 
Peppermint  test  of  plumbing,  169 


Percolating   filtration   for   sewage 

disposal,  213 
Perflation,  163 
Pernicious  malaria,  74 
Personal  cleanliness,  32 
hygiene,  31 

in  arctic,  249 

Phenacetin  habit,  281 

Physical  education,  41 

training,  41 

aptitude,  55 

condition,  55 

facilities,  55 

factors  to  be  considered,  55 
for  military  purposes,  45 
importance  to  state,  43 
instruction  material,  49 
methods,  48 
military  methods,  49 
modern  tendency,  45 
necessity,  41 
object,  44 

racial   attributes   to   be   con- 
sidered, 48 

requirements  for  military  ser- 
vice, 46 
time,  55 

use  of  material,  56 
Physiology,  32 
Pickelhaube,  94 
Pits  for  liquid  garbage  in  camps, 

228 

privy,  207 
Plague,  83 

pneumonic,  84 
Plasmon,  158 
Plumbing  of  barracks,  173 
of  posts,  167 
peppermint  test  of,  169 
testing  of,  169 
Pneumonic  plague,  84 
Poisoning,  ptomain-,  160 
Poison-ivy,  87 


300 


INDEX 


Poison-oak,  87 

Poisonous  effects  of  alcohol,  272 

Pole  seat  for  sink,  223 

Police,  40,  170 

of  camp,  189 

of  transports,  179 
Poncho,  97 
Porter,  259 
Posts,  inspection,  177 

plumbing  of,  107 

sanitation  of,  161 

sites  for,  161 
Potatoes,  149 
Pox,  254 

Precipitation  of  water,  127 
Preserved  meats,  146 
Preventable  diseases,  18,  59 
Prickly  heat  in  tropics  244 
Privy  pits,  207 
Prophylaxis,  results  of,  19 
Proteins,  141 

functions,  142 
Protoplasm,  263 
Protozoa,  61 
Ptomain-poisoning,  160 
Public  health,  17 

service  latrine,  208 
Puttee,  99 

QUARTERS,  care  of,  172 
Quick  time  marching,  50 

RACIAL     attributes     in     physical 

training,  48 
Railroad  journeys,  186 
Rainwater,  123 
Range,  field,  157 
Ration,  143 

arctic,  159 

balanced,  143 

emergency,  155 

haversack,  155 

iron,  158 


Ration,  tropical,  159 

U.  S.  A.,  153 
Rats,  breeding  of,  170 

destruction  of,  170 

in  transmission  of  plague,  83,  84 
Reading  rooms,  39 
Recreation,  39 
Recruiting,  23 
Recruits,  23 

age,  28 

character,  27 

chest  measurement,  28 

defects,  26 

depots,  29 

examination,  26 

height,  28 

high  motives,  24 

lowered  standards,  24 

mental  condition,  27 

nervous  condition,  27 

percentage  qualified,  23 

records,  29 

special  abilities,  24 

vaccination,  30 

weight,  28 
Red  bugs,  86 
Reed  trough,  191,  220 
Reed,  Walter,  and  yellow  fever,  82 
Refrigeration  of  meat,  146 
Refuse,  206 

disposal  of,  in  arctic,  249 
Regulars,  25 
Regulations,  sanitary,  enforcement 

of,  21 

Remittent  fever,  74 
Rest,  39 
Rice,  149 

polished,  84 

undermilled,  84,  159 
Rifle,  117 

exercises,  52 
Roaches,  175 
Roasting  of  meats,  152 


INDEX 


301 


Rolling  kitchens,  157 

Rubbish,  disposal  of,  in  camps,  230 

in  garrison,  217 
Rum,  261 
Running,  51 

SAB  HE  exercises,  52 

Saliva  in  transmission  of  typhoid 

fever,  66 
Salts,  143 

Salvarsan  in  syphilis,  255 
Sand  filtration  of  water,  128 
Sanitary  aid  stations  and  lines  of 

evacuation,  201 

regulations,  enforcement  of,  21 
rules  on  transports,  179 
troops,  17,  200 
Sanitation,  definition  of,  17 
of  barracks,  172 
of  battlefields,  199 
of  camps,  187 
of  marches,  181 
of  posts,  161 
of  transports,  177 
Sausage,  pea,  159 
Scarlatina,  81 
Scarlet  fever,  81 
Scurvy,  84,  159 

in  arctic  service,  247 
Seasickness  on  transports,  179 
Seats  for  sinks,  box,  221 

pole,  223 

Sedimentation  of  water,  127 
Septic  tank  for  sewage  disposal,  213 
Serum,  antimeningitic,  80 
Setting-up  exercises,  50 
Sewage,  disposal  of,  in  garrison,  212 
biologic  methods,  212 
chemical  treatment,  212 
contact  filtration,  213 
discharge  into  sea  or  other 

waters,  212 
irrigation,  212 


Sewage,  disposal  of,  in  garrison, 
percolating  filtration,  213 
septic  tank,  213 
farming,  212 
pollution  of  water-supply,  125 

determination,  126 
Sewer  air,  212 
Sewerage,  system  of,  167 

for  removal  of  excreta,  211 
Sexual  indulgence,  36 
Shelter  tent,  116 
Shock,  surgical,  alcohol  in,  270 
Shoes,  87,  102 
breaking  in,  106 
civilian  models,  104 
how  to  fit,  105 
requirements  for  good,  103 
soiled,  in  transmission  of  typhoid 

fever,  66 

supervision  in  fitting,  105 
waterproofing,  107 
Shower-baths,  167 
Sick  call  for  marching  command, 

197 
evacuation    of,    on    battlefields, 

199 
Sinks,  care  of,  173 

in  camps,  189,  192,  221 
seats  forv  box,  221 

pole,  223 
Siphon  closet,  168 
Siphonage,  167 
Skin  diseases,  34 

in  tropics,  244 
eruptions,  86 
Sleep,  39 
Sleeping  bag,  249 
Slicker,  97 
Small-pox,  81 
in  tropics,  244 
vaccination  against,  81 
Snake-bite,  alcohol  in,  270 
Snow-blindness,  247 


302 


INDEX 


Socks,  88,  101 

Sod  crematory  for  camps,  231 
Soft  chancre,  256 
Soil-pipes,  168 

Soldiers   and    disease    prevention, 
20 

dependency  of,  59 

inexperienced,  60 
Soups,  cooking  of,  152 
Spanish-American    War,    typhoid 

fever  in,  64 
Spirilla,  60 
Spirits,  260 

Spitting  in  tuberculosis,  77 
Spray  pump,  171 
Stables,  sanitation  of,  170 
Starch,  animal,  142 
State,  importance  of  physical  train- 
ing to,  43 
Stegomyia  calopus,  82 

mosquitoes,  75 
Sterilization,  62 

of  water,  135 

Sterilizer,  Forbes',  135,  136 
Stewing  of  meats,  152 
Stomach,    effects    of    alcohol    on, 

265 

Straddle  trench,  225 
Sugar,  149 

Surgical  shock,  alcohol  in,  270 
Surplus  kit  bag,  1 19 
Sutlers,  195 
Sweater,  96 
Sweeping,  173 
Sweepings,  disposal  of,  in  camps, 

230 

in  garrison,  217 
Swimming,  54 
Syphilis,  254 

hereditary,  255 

marriage  in,  255 

salvarsan  in,  255 

transmission  of,  255 


TAPEWORMS,  160 

Taps,  waste  from,  disposal  of,  in 

camps,  233 
Tea,  151 

habit,  282 
Teeth,  care  of,  33 
Temperature  in  cooking,  153 
Tenderfoot  knee,  247 
Tent,  care  of,  195 

pyramidal,  187 

shelter,  116 

Test,  peppermint,  of  plumbing,  169 
Thirst  on  marches,  184 
Throat  affections,  78 
Ticks,  86 

Tiger  mosquito,  82 
Tissues,  effects  of  alcohol  on,  262 
Tobacco,  280 

effects,  280 

habit,  281 

nature,  280 
Tonsillitis,  78 
Training,  physical,  41.  See  also 

Physical  training. 
Transports,  messing  on,  178 

personal  hygiene  on,  176 

police  of,  179 

sanitary  rules  on,  179 

sanitation  of,  177 

seasickness  on,  179 

ventilation  of,  177 

water-supply  of,  179 
Trap,  167 

fly,  175 

Trichinosis,  160 
Troops,  care  of,  17 

sanitary,  17 

Troopships,  sanitation,  177 
Tropical  climate,  235 

ration,  159 

service,  235 
Tropics,  235 

abdominal  congestion  in,  239 


INDEX 


303 


Tropics,    abdominal    covering 
wool  in,  241 

acclimatization,  238 

baths  in,  238 

causes  of  disease  in,  237 

cholera  in,  244 

clothing  in,  240 

dhobie  itch  in,  244 

diet  in,  239 

diseases  in,  242 

drinking-water  in,  240 

dysentery  in,  243 

effects  of,  236 

exercise  in,  241 

field  service  in,  245 

habitations  in,  242 

hat  in,  241 

headgear  in,  241 

homesickness  in,  245 

houses  in,  242 

intestinal  diseases  in,  243 
parasites  in,  244 

laundry  in,  239 

malaria  in,  243 

nostalgia  in,  245 

prickly  heat  in,  244 

skin  diseases  in,  244 

small-pox  in,  244 

underclothing  in,  241 

venereal  diseases  in,  244 

water  in,  240 
Trousers,  97 
Tubercle  bacillus,  77 
Tuberculosis,  77 

alcohol  in,  270 

bacillus  of,  77 

coughing  and  spitting,  77 

from  infected  food,  159 

prevention  of,  78 
Typhoid  bacillus,  65 

fever,  63 

army  epidemics,  65 
carriers,  65,  66 


of 


Typhoid  fever,  cause,  64 

dust  in  transmission  of,  67 

flies  in  transmission  of,  66,  67 

from  infected  food,  159 

hands  in  transmission  of,  66 

immunity  from,  71 

in  Boer  War,  63 

in  civil  communities,  64 

War,  63 

in  Franco-Prussian  War,  63 
in  Spanish-American  War,  64 
method  of  spread,  65 
prevention,  67 
saliva  in  transmission  of,  66 
scourge  of  armies,  63 
soiled  shoes  in  transmission  of, 

66 
vaccination  against,  67.     See 

also  Vaccination,  antityphoid. 

ULTRAVIOLET  rays,  purification  of 

water  by,  129 

Underclothing  in  tropics,  241 
Undershirts,  100 
Underwear,  33,  100 
Uniform,  service,  98 
Urinal  cans,  224 
Urine,  disposal  of,  in  camps,  224 

VACCINATION  against  small-pox,  81 
antityphoid,  67 
history  of,  67 
immunity  from,  71 
in  American  Army,  69 
in  British  Army,  68 
in  German  Army,  68 
preparation  of  material,  70 
of  recruits,  30 
Vacuum  cleaning,  173 
Varioloid,  81 
Vaulting,  52 
Vegetables,  canned,  156 
cooking  of,  153 


304 


INDEX 


Vegetables,  fresh,  156 

green,  150 
Vegetins,  25 

Venereal  diseases,  62,  250 
action  by  Congress,  253 

by  War  Department,  252 
causes,  251 

education  campaign,  252 
importance,  250 
in  tropics,  244 
personal  prophylaxis,  257 
prevalence  in  army,  250 
preventive  measures,  251 
Ventilation,  37,  163 
of  transports,  177 
Vino,  261 

dangers  of,  240 
Visual  apparatus,  effects  of  alcohol 

on,  266 
Vital  processes,  effects  of  alcohol 

on,  262 

Vitality,  effects  of  alcohol  on,  267 
Volunteers,  inexperience  of,  25 

WASH  water,  disposal  of,  in  camps, 

233 
Washing   hands   after   defecation, 

225 

Waste-pipes,  draining  fixtures,  168 
Wastes,  206 

classification,  206 
disposal  of,  206 
in  camps,  190,  218 
in  garrison,  207 

separation   of   components, 

214 

sewers,  211 
from  taps,  disposal  of  in  camps, 

233 

liquid  house,  disposal,  in  garri- 
son, 216 
solid,  206 
Water,  143 


Water,  drinking-,  in  tropics,  240 

in  tropics,  240 
wash,    disposal    of,    in    camps, 

233 

|  Water-closet,  167 
dry  earth,  207 
Public  Health  Service,  208 
Waterproofing  of  clothing,  92 

shoes,  107 
Water-supply,  122 
bacteria  in,  125 
destruction,  135 
removal,  130 
functions,  122 
hardness,  124 
impurities,  124 
necessity,  122 
of  battlefield,  202 
of  camps,  193 
of  transports,  179 
pollution,  125 
from  sewage,  125 

determination,  126 
purification,  127 

by  addition  of  copper  sulphate, 

128 

by  chlorin  gas,  129 
by  filtration,  128 
by  ozone,  129 
by  precipitation,  127 
by  sedimentation,  127 
by  ultraviolet  rays,  129 
in  field,  130 
boiling,  137 
chemical,  131 
Darnall  filter,  131 
filtration,  131 
Forbes'  sterilizer,  135,  136 
improvised  filter,  134 
sterilization,  135 
methods  of,  on  large  scale,  127 

on  small  scale,  129     - 
removal  of  bacteria,  130 


INDEX 


305 


Water-supply,     purification,     re- 
moval   of  objectionable  sub- 
stances, 129 
quantity  required,  123 

sources,  123 
Weight  of  equipment,  108 

of  recruits,  28 
Whisky,  260 
blended,  260 
straight,  260 
Wines,  259 
Wise,  quotation,  22 
Wood  alcohol,  262 
20 


Wooden  floors,  care  of,  172 
Woodhull,  25,  139 
Wool  as  clothing,  90 

disadvantages,  91 

merits  of,  90 

washing,  91 
Worry,  39 

Wounded,  care  of,  200 
Wounds,  location  of,  203 

YEAST  plant,  258 
Yellow  fever,  82 

mosquitoes  and,  82 


XT 
11 ' 

PUBLISHED  BY 

SAUMDERS   COMPANY 


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Da^agKerty's  Economic  Zoftlogy 

Economic  Zoology.  By  L.  S.  DAUGHERTY,  M.  S.,  Ph.  D.,  Professor 
of  Zoology,  State  Normal  School,  Kirksville,  Mo.;  and  M.  C. 
DAUGHERTY.  Part  I — Field  and  Laboratory  Guide:  12010  of  237 
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Prof.  V.  E.  Shelf ord,  University  of  Chicago:  "  It  has  many  merits  and 
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Nutritional  Physiology.  By  PERCY  G.  STILES,  Assistant  Pro- 
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admirable  features,  the  most  valuable  of  which  is  the  careful  resume  of 
the  subjects  of  heredity  and  evolution." 


Invertebrate  Zoology.  By  OILMAN  A.  DREW,  Ph.  D.,  Assistant  Di- 
rector of  the  Marine  Biological  Laboratory,  Woods  Hole,  Mass. 
i2mo  of  213  pages.  Cloth,  $1.25  net.  New  (2d)  Edition. 

Professor  Drew's  work  gives  the  student  a  working  knowledge  of  com- 
parative anatomy  and  leads  him  to  an  appreciation  of  the  adaptation 
of  the  animals  to  their  environments.  It  is  a  practical  work,  express- 
ing the  practical  knowledge  gained  through  experience.  The  type 
method  of  study  has  been  followed. 

Prof.  John  M.  Tyler,  Amherst  College:  "It  covers  the  ground  well^ 
is  clear  and  very  compact.  The  table  of  definitions  is  excellent." 


American  Pocket  Medical  Dictionary.  Edited  by  W.  A.  NEW- 
MAN BORLAND,  M.  D.  677  pages.  Flexible  leather,  $1.00  net; 
thumb  index,  $1.25  net.  Eighth  Edition. 

A  dictionary  must  be  full  enough  to  give  the  student  the  information 
he  seeks,  clearly  and  simply,  yet  it  must  not  confuse  him  with  detail. 
The  editor  has  kept  this  in  mind  in  compiling  this  Pocket  Dictionary, 
and  he  has  produced  a  work  of  great  value  to  the  student.  There  are 
over  100,000  American  Medical  Dictionaries  now  in  use. 
I.  V.  S.  Stanislaus,  M.D.,  Medico-Chirurgical  College:  "We  have 
been  strongly  recommending  this  little  book  as  being  the  very  best." 


Saunders*  College  Text-Books 


lBmekaifiiiiifiis'§  \f  (gferiimairy  Bacteriology 

Veterinary  Bacteriology.  By  ROBERT  E.  BUCHANAN,  Ph.  D., 
Professor  of  Bacteriology  in  the  Iowa  State  College  of  Agriculture 
and  Mechanic  Arts.  Octavo  of  516  pages,  214  illustrations. 
Cloth,  $3.00  net. 

Professor  Buchanan's  new  work  goes  minutely  into  the  consideration 
of  immunity,  opsonic  index,  reproduction,  sterilization,  antiseptics, 
biochemic  tests,  culture  media,  isolation  of  cultures,  the  manufacture 
of  the  various  toxins,  antitoxins,  tuberculins,  and  vaccines. 
B.  F.  Kaupp,  D.  V.  S.,  State  Agricultural  College,  Fort  Collins:  "  It  is 
the  best  in  print  on  the  subject.  What  pleases  me  most  is  that  it  con- 
tains all  the  late  results  of  research." 

Sissop's   V<rt«rin»lry.          torn j 

Veterinary  Anatomy.  By  SEPTIMUS  SISSON,  S.  B.,  V.  S.,  Pro- 
fessor of  Comparative  Anatomy,  Ohio  State  University.  Octavo 
of  826  pages,  588  illustrations.  Cloth,  $7.00  net.  The  Standard. 

Here  is  a  work  of  the  greatest  usefulness  in  the  study  and  pursuit  of 
the  veterinary  sciences.  This  is  a  clear  and  concise  statement  of  the 
structure  of  the  principal  domesticated  animals — an  exhaustive  gross 
anatomy  of  the  horse,  ox,  pig,  and  dog,  including  the  splanchnology  of 
the  sheep,  presented  in  a  form  never  before  approached  for  practical 
usefulness. 

Prof.  E.  D.  Harris,  North  Dakota  Agricultural  College:  "  It  is  the  best 
of  its  kind  in  the  English  language.  It  is  quite  free  from  errors." 


Ophthalmology  for  Veterinarians.  By  WALTER  N.  SHARP,  M.  D., 
Professor  of  Ophthalmology,  Indiana  Veterinary  College,  ismo 
of  210  pages,  illustrated.  Cloth,  $2.00  net. 

This  new  work  covers  a  much  neglected  but  important  field  of  veter- 
inary practice.  Dr.  Sharp  has  presented  his  subject  in  a  concise,  crisp 
way,  so  that  you  can  pick  up  his  book  and  get  to  "  the  point "  quickly. 
He  first  gives  you  the  anatomy  of  the  eye,  then  examination,  followed 
by  the  various  diseases,  including  injuries,  parasites,  errors  of  refrac- 
tion, and  medicines  used  in  ophthalmic  therapeutics.  The  text  is 
illustrated. 


Saunders'  College  Text-Books 


Personal  Hygiene.  Edited  by  WALTER  L.  PYLE,  M.  D.,  Fellow 
of  the  American  Academy  of  Medicine.  12010  of  515  pages,  illus- 
trated. Cloth,  $1.50  net.  Fifth  Edition. 

Dr.  Pyle's  work  sets  forth  the  best  means  of  preventing  disease — the  best 
means  to  perfect  health.  It  tells  you  how  to  care  for  the  teeth,  skin, 
complexion,  and  hair.  It  takes  up  mouth  breathing,  catching  cold, 
care  of  the  vocal  cords,  care  of  the  eyes,  school  hygiene,  body  posture, 
ventilation,  house-cleaning,  etc.  There  are  chapters  on  food  adulter- 
ation (by  Dr.  Harvey  W.  Wiley),  domestic  hygiene,  and  home  gymnastics. 
Canadian  Teacher:  "Such  a  complete  and  authoritative  treatise 
should  be  in  the  hands  of  every  teacher." 


Personal  Hygiene  and  Physical  Training  for  Women  By 
ANNA  M.  GALBRAITH,  M.  D.,  Fellow  New  York  Academy  of 
Medicine.  12010  of  371  pages,  illustrated.  Cloth,  $2.00  net. 

Dr.  Galbraith's  book  meets  a  need  long  existing — a  need  for  a  simple 
manual  of  personal  hygiene  and  physical  training  for  women  along  sci- 
entific lines.  There  are  chapters  on  hair,  hands  and  feet,  dress,  devel- 
opment of  the  form,  and  the  attainment  of  good  carriage  by  dancing, 
walking,  running,  swimming,  rowing,  etc. 

Dr.  Harry  B.  Boice,  Trenton  State  Normal  School:  "It  is  intensely 
interesting  and  is  the  finest  work  of  the  kind  of  which  I  know." 


Exercise  in  Education  and  Medicine.  By  R.  TAIT  McKnNZiB, 
M.  D.,  Professor  of  Physical  Education,  University  of  Pennsyl- 
vania. Octavo  of  406  pages,  with  346  illustrations.  Cloth,  $3.50 
net.  Adopted  by  U.  S.  Army. 

Chapters  of  special  value  in  college  work  are  those  on  exercise  by  the 
different  systems:  play-grounds,  physical  education  in  school,  college, 
and  university. 

D.  A.  Sargent,  M.  D.,  Hemenway  Gymnasium:  "It  should  be  in  the 
hands  of  every  physical  educator." 


Saunders*  College  Text-Books 


Normal  Histology  and  Organography.    By  CHARLES  HILL,  M.  D. 
i2mo  of  468  pages,  337  illustrations.     Flexible  leather,  $2.00  net. 

Second  Edition. 

Dr.  Hill's  work  is  characterized  by  a  brevity  of  style,  yet  a  complete- 
ness of  discussion,  rarely  met  in  a  book  of  this  size.  The  entire  field 
is  covered,  beginning  with  the  preparation  of  material,  the  cell,  the 
various  tissues,  on  through  the  different  organs  and  regions,  and  end- 
ing with  fixing  and  staining  solutions. 

Dr.  E.  P.  Porterfield,  St.  Louis  University:  "  I  am  very  much  gratified 
to  find  so  handy  a  work.  It  is  so  full  and  complete  that  it  meets  all 
requirements." 


m,  11 

Histology.  By  A.  A.  B5HM,  M.  D.,  and  M.  VON  DAVIDOFF, 
M.  D.,  of  Munich.  Edited  by  G.  CARL  HUBER,  M.  D.,  Professor 
of  Embryology  at  the  Wistar  Institute,  University  of  Pennsyl- 
vania. Octavo  of  528  pages,  377  illustrations.  Flexible  cloth,  $3.50 
net.  Second  Edition. 

This  work  is  conceded  to  be  the  most  complete  text-book  on  human 
histology  published.  Particularly  full  on  microscopic  technic  and 
staining,  it  is  especially  serviceable  in  the  laboratory.  Every  step  in 
technic  is  clearly  and  precisely  detailed.  It  is  a  work  you  can  depend 
upon  always. 

New  York  Medical  Journal:  "There  can  be  nothing  but  praise  for 
this  model  text-book  and  laboratory  guide." 

Htttftttfr  Embryology 

Embryology.  By  J.  C.  HEISLER,  M.  D.,  Professor  of  Anatomy, 
Medico-Chirurgical  College  of  Philadelphia.  Octavo  of  432  pages, 
205  illustrations.  Cloth,  $3.00  net.  Third  Edition. 

A  book  of  the  greatest  teaching  value.  The  subject  is  taken  up  sys- 
tematically, treating  the  development  of  each  tissue,  each  organ,  each 
region  and  system  in  a  most  thorough  way.  There  are  frequent  allu- 
sions to  certain  facts  of  comparative  embryology. 
Journal  American  Medical  Association :  "  The  text  is  concise,  and 
yet  sufiiciently  full  for  a  text-book." 


Saunders*  College  Text-Books 


General  Bacteriology.  By  EDWIN  O.  JORDAN,  Ph.  D.,  Professor 
of  Bacteriology,  University  of  Chicago.  Octavo  of  623  pages, 
illustrated.  Cloth,  $3.00  net.  Third  Edition. 

This  work  treats  fully  of  the  bacteriology  of  plants,  milk  and  milk 
products,  dairying,  agriculture,  water,  food  preservation;  of  leather 
tanning,  vinegar  making,  tobacco  curing;  of  household  administration 
and  sanitary  engineering.  A  chapter  of  prime  importance  to  all  stu- 
dents of  botany,  horticulture,  and  agriculture  is  that  on  the  bacterial 
diseases  of  plants. 

Prof.  T.  J.  Burrill,  University  of  Illinois:  "  I  am  using  Jordan's  Bac- 
teriology for  class  work  and  am  convinced  that  it  is  the  best  text  in 
existence." 


Bacteriologic  Technic.  By  J.  W.  H.  EYRE,  M.  D.,  Bacteriologist 
to  Guy's  Hospital,  London.  Octavo  of  525  pages,  illustrated. 
Cloth,  $3.00  net.  Second  Edition. 

Dr.  Eyre  gives  clearly  the  technic  for  the  bacteriologic  examination  of 
water,  sewage,  air,  soil,  milk  and  its  products,  meats,  etc.  It  is  a  work 
of  much  value  in  the  laboratory.  The  illustrations  are  practical  and 
serve  well  to  clarify  the  text.  The  book  has  been  greatly  enlarged. 
The  London  Lancet:  "  It  is  a  work  for  all  technical  students,  whether 
of  brewing,  dairying,  or  agriculture." 


Laboratory  Bacteriology.  By  FREDERIC  P.  GORHAM,  A.  M., 
Associate  Professor  of  Biology,  Brown  Jniversity,  Providence. 
i2mo  of  192  pages,  illustrated.  C'oth,  $1.25  net. 

The  subjects  of  special  interest  to  scientific  students  are  the  identifica- 
tion of  bacteria  of  water,  milk,  air,  and  soil.  Professor  Gorham  has 
succeeded  in  making  his  instructions  clear  and  easily  grasped  by  the 
student.  The  text  is  illustrated. 

Science:  "  The  author  has  described  small  points  of  technic  usually 
left  for  the  student  to  learn  himself." 


Saunders*  College  Text-Books 


Elements  of  Nutrition.  By  GRAHAM  LUSK,  Ph.  D.,  Professor  of 
Physiology,  Cornell  Medical  School.  Octavo  of  402  pages,  illus 
trated.  Cloth,  $3.00  net.  Second  Edition. 

The  clear  and  practical  presentation  of  starvation,  regulation  of  tem- 
perature, the  influence  of  protein  food,  the  specific  dynamic  action 
of  food-stuffs,  the  influence  of  fat  and  carbohydrate  ingestion  and  of 
mechanical  work  render  the  work  unusually  valuable.  It  will  prove 
extremely  helpful  to  students  of  animal  dietetics  and  of  metabolism 
generally. 

Dr.  A.  P.  Brubaker,  Jefferson  Medical  College:  "  It  is  undoubtedly  the 
best  presentation  of  the  subject  in  English.  The  work  is  indispensable." 

Physiology.  By  WILLIAM  H.  HOWELL,  M.  D.,  Ph.  D.,  Professor 
of  Physiology,  Johns  Hopkins  University.  Octavo  of  1020  pages, 
illustrated.  Cloth,  $4.00  net.  Fifth  Edition. 

Dr.  Howell's  work  on  human  physiology  has  been  aptly  termed  a 
"storehouse  of  physiologic  fact  and  scientific  theory."  You  will  at 
once  be  impressed  with  the  fact  that  you  are  in  touch  with  an  expe- 
rienced teacher  and  investigator. 

Prof.  G.  H.  Caldwell,  University  of  North  Dakota:  "Of  all  the  text- 
books on  physiology  which  I  have  examined,  Howell's  is  the  best." 


Hygiene.  By  D.  H.  BERGEY,  M.  D.,  Assistant  Professor  of  Bac- 
teriology, University  of  Pennsylvania.  Octavo  of  530  pages,  illus- 
trated. Cloth,  $3.00  net.  Fourth  Edition. 

Dr.  Bergey  gives  first  place  to  ventilation,  water-supply,  sewage,  indus- 
trial and  school  hygiene,  etc.  His  long  experience  in  teaching  this  sub- 
ject has  made  him  familiar  with  teaching  needs. 

J.  N.  Hurty,  M.  D.,  Indiana  University:  "It  is  one  of  the  best  books 
with  which  I  am  acquainted." 


Saunders'  College  Text-Books 


OffTOW^fi 

Immediate  Care  of  the  Injured.  By  ALBERT  S.  MORROW,  M.D., 
Adjunct  Professor  of  Surgery,  New  York  Polyclinic.  Octavo  of 
360  pages,  242  illustrations.  Cloth,  $2.50  net.  Second  Edition- 

Dr.  Morrow's  book  tells  you  just  what  to  do  in  any  emergency,  and  it 
is  illustrated  in  such  a  practical  way  taat  the  idea  is  caught  at  once. 
There  are  chapters  on  bandaging,  practical  remedies,  first-aid  outfit, 
hypodermic  injections,  antiseptics  and  disinfectants,  accidents  and 
emergencies,  hemorrhages,  inflammation,  contusions  and  wounds,  burns 
and  scalds,  the  injurious  effects  of  cold,  fractures  and  dislocations, 
sprains,  removal  of  foreign  bodies  from  the  eye,  ear,  nose,  etc.,  poisons, 
and  their  antidotes.  There  is  no  book  better  adapted  to  first-aid  class 
work. 

Health :  "  Here  is  a  book  that  should  find  a  place  in  every  workshop 
and  factory  and  should  be  made  a  text-book  in  our  schools." 


American  Illustrated  Medical  Dictionary.  By  W.  A.  NEWMAN 
DORLAND,  M.  D.,  Member  of  Committee  on  Nomenclature  and 
Classification  of  Diseases,  American  Medical  Association.  Octavo 
of  1107  pages,  with  3  23  illustrations,  119  in  colors.  Flexible 
leather,  $4.50  net ;  thumb  indexed,  $5.00  net.  Seventh  Edition 

If  you  want  an  unabridged  medical  dictionary,  this  is  the  one  you 
want.  It  is  down  to  the  minute;  its  definitions  are  concise,  yet  accu- 
rate and  clear;  it  is  extremely  easy  to  consult;  it  defines  all  the  newest 
terms  in  medicine  and  the  allied  subjects;  it  is  profusely  illustrated. 
This  new  edition  alone  defines  over  5000  new  terms  not  defined  in  any 
other  medical  dictionary — bar  none.  There  is  no  other  medical  dic- 
tionary that  will  meet  your  needs  as  well  as  The  American  Illustrated. 
Why  not  then  get  the  best  ? 

John  B.  Murphy,  M. D.,  Northwestern  University:  "It  is  unquestion- 
ably the  best  lexicon  on  medical  topics  in  the  English  language,  and, 
with  all  that,  it  is  so  compact  for  ready  reference." 

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